Erectile Dysfunction as an Obesity-Related Condition in Elderly Men with Coronary Artery Disease

Background: This cross-sectional study aimed to investigate the prevalence of erectile dysfunction (ED) in elderly men with overweight or obesity and coronary artery disease. Methods: Patients recruited in cardiac rehabilitation centers post-myocardial infarction provided demographic and anthropomorphic data. ED was assessed using the abbreviated International Index of Erectile Function 5 (IIEF-5) Questionnaire. Results: The study included 661 men with a mean age of 67.3 ± 5.57 years, a mean BMI of 27.9 ± 3.6 m/kg2, and a mean waist circumference of 98.9 ± 10.23 cm. Over 90% of men experienced ED, with similar proportions across BMI categories. The development of ED in men with a waist circumference of ≥100 cm had 3.74 times higher odds (OR 3.74; 95% CI: 1.0-13.7; p = 0.04) than in men with a waist circumference of <100 cm. Men with obesity and moderate-to-severe and severe ED were older compared to those without these disorders (67.1 ± 5.29 vs. 65.3 ± 4.35; p = 0.23). Conclusions: The prevalence of ED in men with coronary artery disease surpasses 90%. An increased body weight raises the risk of ED, with waist circumference proving to be a more reliable predictor of this risk compared to BMI. Physicians are encouraged to screen elderly patients with cardiovascular disease for ED and address obesity to enhance overall health.

Association between Leukocyte Cell-Derived Chemotaxin 2 and Metabolic and Renal Diseases in a Geriatric Population: A Pilot Study

LECT2 is not a routine diagnostic marker for any disease, but it has been associated with many pathologies, including systemic amyloidosis, rheumatoid arthritis, diabetes, atherosclerosis, and metabolic syndrome. With human aortic sections (n = 22) and sera from geriatric subjects (n = 79), we analyzed the relationships that could be observed between this protein and other parameters related to metabolic diseases. As a result, we observed a relatively high (r~0.8, p < 0.05) positive correlation between SRA and LECT2 and a negative correlation between EGFR and LECT2 (r~-0.4, p < 0.05). We observed LECT2 expression in macrophages, myocytes, and other aortic cells, with a tendency to be overexpressed in developed atherosclerotic plaques. We conclude that LECT2 exerts its chemotactic effects not only as a protein synthesized in the liver and secreted and circulating in the blood but also as a locally expressed protein within atherosclerotic plaque development. The LECT2-EGFR correlation suggests an association of this protein with loss of normal renal function. This fact can be associated with LECT2 amyloidosis, although it should be verified whether in the geriatric population there is indeed a widespread accumulation of LECT2 with the progression of aging or whether it is rather a marker of general deterioration of renal function.

Impact of Internet Addiction, Social Media Use and Online Pornography on the Male Sexual Function in Times of the COVID-19 Pandemic

Over recent decades, the use of the Internet has dramatically increased, both for professional purposes and entertainment. We investigated the link between social media use, video games, dating apps, and pornography on men's sexual health, which makes life easier, but also carries potential threats. Online surveys including The International Index of Erectile Function (IIEF) and Bergen Social Media Addiction Scale questionnaires were spread to young, sexually active men. We asked about demographics, sexual activity, and the use of social media, video games, dating apps, and pornography. We enrolled 702 men aged 18 to 60 years (mean 24.06 ± 5.70). In general, 1.6% of men were exposed to social media addiction. Social media addiction had a negative impact on IIEF scores, while pornography in general had no impact on men's sexual health. However, more extensive use of pornography was correlated with lower IIEF scores. A negative impact of dating apps use on the IIEF score was also found but the correlation was weak (p = 0.049). No correlation was found between playing games and IIEF. We conclude that social media addiction negatively affected men's sexual functioning during the COVID-19 pandemic. The development of strategies for the safe use of the Internet and dissemination of this knowledge through social media campaigns can help young people to recognize the first symptoms of social media addiction.

What Do We Know about Nociplastic Pain?

Nociplastic pain is a recently distinguished type of pain, distinct from neuropathic and nociceptive pain, and is well described in the literature. It is often mistaken for central sensitization. Pathophysiology has not been clearly established with regard to alteration of the concentration of spinal fluid elements, the structure of the white and gray matter of the brain, and psychological aspects. Many different diagnostic tools, i.e., the painDETECT and Douleur Neuropathique 4 questionnaires, have been developed to diagnose neuropathic pain, but they can also be applied for nociplastic pain; however, more standardized instruments are still needed in order to assess its occurrence and clinical presentation. Numerous studies have shown that nociplastic pain is present in many different diseases such as fibromyalgia, complex regional pain syndrome type 1, and irritable bowel syndrome. Current pharmacological and nonpharmacological treatments for nociceptive and neuropathic pain are not entirely suitable for treating nociplastic pain. There is an ongoing effort to establish the most efficient way to manage it. The significance of this field has led to several clinical trials being carried out in a short time. The aim of this narrative review was to discuss the currently available evidence on pathophysiology, associated diseases, treatment possibilities, and clinical trials. It is important that physicians widely discuss and acknowledge this relatively new concept in order to provide optimized pain control for patients.

Low Exercise Tolerance as a Marker of Erectile Dysfunction and Depression among Post-Myocardial Infarction Men

Evidence has grown recently on the correlation between lifestyle and physical activity, and their impact on the functioning of the entire organism. In addition, a decrease in physical efficiency may be an indicator of the early diagnosis of systemic diseases. The aim of this study was to determine whether there is a relationship between exercise tolerance and possible erectile dysfunction or mental disorders. A cross-sectional study was conducted among 254 men in 4 cardiac rehabilitation centers in Poland using the standardized International Index of Erectile Function 5 (IIEF-5) and Beck Depression Inventory (BDI) questionnaires. Erectile dysfunction was directly proportional to the metabolic equivalent of the task (MET) variable. An increase in exercise tolerance by 1 point was associated with an increase in the IIEF-5 score by 1.62 points, indicating a reduction in the severity of erectile dysfunction. The 1-point increase in MET was associated with a 1.8-point decrease in BDI, indicating that an increase in exercise tolerance is associated with a decrease in the severity of depressive disorders. Increasing the tolerance of physical effort has a beneficial effect not only on the general well-being, but also on the sexual and mental health of men. An increase in exercise tolerance is associated with a reduction in the incidence of erectile dysfunction. On the other hand, in patients with depressive disorders, the improvement of exercise tolerance reduces the intensity of depression symptoms. Exercise tolerance can be an early and simple marker at the onset of erectile dysfunction or mood disorders.

Diet Quality Variation among Polish Older Adults: Association with Selected Metabolic Diseases, Demographic Characteristics and Socioeconomic Status

A lot of civilization diseases are related to a low-quality diet, which is often determined by environmental factors. The aim of the present study was to assess the relationship between the quality of diet and the selected metabolic diseases, as well as demographic characteristics and socioeconomic status among Polish seniors. The study was conducted on the basis of the KomPAN questionnaire (Questionnaire for Dietary Views and Habits). The research sample was chosen arbitrarily. In addition, in order to diversify the research sample, the use of the snowball method was used. The study was conducted from June to September 2019 in a group of 437 people aged 60 or more years in two regions of Poland. Two diet quality indices with a potentially beneficial (pHDI-10) and adverse impact on health (pHDI-14) were selected based on data on the frequency of consumption of 24 food groups using the KomPAN questionnaire data development procedure. Based on the intensities (low, moderate, high) and combinations of these indices, three diet quality index profiles were developed with potentially different influences on health: lower (lowest), middle (intermediate) and upper (highest). Logistic regression was used to evaluate the relationship between diet quality indices, some metabolic diseases (obesity, arterial hypertension, diabetes type 2), demographic characteristics (gender, age, place of residence), and socioeconomic status (low, moderate, high). It was shown that in the examined seniors with selected metabolic diseases, the higher quality diet was more common among women, urban inhabitants and subjects with higher socioeconomic status. In turn, among the elderly with obesity, a high-quality diet was observed more often in people aged 60-74 years and those with type II diabetes at ages 75 years or more. The relationships between diet quality, demographic characteristics and socioeconomic status were demonstrated, but it was not possible to obtain unambiguous results on the relationship of these variables with the occurrence of metabolic diseases. Further extended studies should assess the importance of diet quality in reducing the risk of metabolic diseases in the elderly, taking into account the variability resulting from the environmental characteristics of the study population.

Identification of Factors Affecting the Increased Percentage of CGA Recommendations among Patients on Geriatric Ward

In Poland, the elderly population is noticeably increasing every year. Therefore, the current healthcare system has to rise to the challenge of treatment and prevention strategies targeting elderly persons. Based on the Vulnerable Elders Survey (VES-13 scale), consisting of international and validated scales, we put effort into identifying the factors affecting the increased percentage of CGA (Comprehensive Geriatric Assessment) recommendations by healthcare system physicians. The study group involved 78 patients from the Department of Geriatrics, Wroclaw Medical University, Poland, aged 60-91 (median Me = 81 years old). Of the studied patients, 51 were recommended for CGA (51/78; 64.6%). A statistically significant association was observed between CGA recommendation and age (p < 0.001); the likelihood of a CGA recommendation increased with age. Furthermore, the increased CGA recommendation was observed among geriatric patients with: (a) frailty syndrome (OR = 11.2, CI95% 2.88-43.5, p < 0.001), (b) high risk of malnutrition or malnutrition (OR = 3.87; CI95%, 1.00-14.9, p = 0.04), (c) low mental status (OR = 3.32, CI95% 1.22-9.09, p = 0.029), (d) low ability to perform basic daily duties (according to ADL scale-OR = 12.6, CI95% 1.57-101, p = 0.004 and IADL scale-OR = 4.71, CI95% 1.72-12.9, p = 0.003), and (e) fall risk (OR = 15.0, CI95% 4.67-48.3, p < 0.001). Moreover, homocysteine levels increased with age (p = 0.003) and decreased with sleep duration (p = 0.043). Taken together, all these factors seem to be important when implementing treatment programs adjusted to the individual geriatric patient.

The hero of American and Polish nations: a molecular look at Thaddeus Kosciuszko's cause of death suggests a contribution of endocarditis caused by Cutibacterium acnes infection

The remains of the heart tissue of Thaddeus Kosciuszko have been investigated as the possible cause of disease and death of the hero of Polish and American nations. Three specimens, DNA isolated from scrappings of wax surface, from the surface of a wooden plate, and from the linen cloth that have had contact with the object were subjected to nanosequencing. From the first two, among all reads identified, only one classified as Propionibacterium acnes (synonymous current name Cutibacterium acnes), had a purported clinical significance. The observed identity between the P. acnes sequences and reference was 89-90% consistent with the hypothesis that the identified reads represent the ancient P. acnes DNA (aDNA), which underwent fragmentation and sequence changes caused by its long-time presence in the environmental conditions conducive to degradation. We present a reasonable and entirely new hypothesis that the analyzed samples could reflect the presence of the bacteria in the original Kosciuszko's heart tissue and that the process of C. acnes infection was progressing inside the organ (endocarditis), not on its surface (pericarditis) leading to rapid deterioration of health and eventually death. We again point out that normal skin and mucosal membranes commensal, a causative agent of common skin acne, may be associated with various severe organ infections posing a threat to health and life.

Mental and Sexual Health of Men in Times of COVID-19 Lockdown

Due to the worldwide spread of COVID-19, some restrictions were introduced which could lead to the development of distress and somatic symptoms. This survey aimed to study the mental and sexual health of men during the COVID-19 outbreak. An online questionnaire was conducted to collect data on contact with people suspected of infection/infected with the SARS-CoV-2 virus, use of stimulants, and perceived mental and sexual health during isolation among Polish men. They were also asked to answer the Beck Depression Inventory (BDI) and the International Index of Erectile Function (IIEF-15) questionnaire. In total, 606 men with a mean age of 28.46 ± 9.17 years took part in the survey. Fear of contracting the COVID-19 infection had a negative impact on the mental health of 132 men (21.8%). Fear of the health condition of loved ones caused stress and a depressed mood in 253 men (41.7%), and media reports worsened the mental health of 185 men (30.2%). In the BDI, 71.95% of the respondents did not suffer from depressive symptoms, 17.33% were diagnosed with mild depression, 6.11% with moderate depression, and 4.62% had severe depression. The mean score in the IIEF-15 questionnaire in the erectile function domain was 22.27, orgasm-7.63, desire-8.25, satisfaction-10.17, and general satisfaction-6.84. Depressive symptoms indicated more severe sexual functioning disorders (p < 0.001). Fear, following the media, and loneliness were associated with more severe depressive and sexual disorders (p < 0.001). The libido level (p = 0.002) and frequency of sexual activity (p < 0.001) were also lower during the pandemic than before the lockdown. These data showed that the COVID-19 pandemic had a significant impact on male mental and sexual health.

Sociodemographic and Health-Related Factors Influencing Drug Intake among the Elderly Population

Excessive drugs intake among the elderly population, including self-medication, constitutes an important public health problem. Polypharmacy may lead to numerous adverse health effects, which become more prevalent when combined with biological changes in seniors. In this cross-sectional study, 500 Polish adults aged ≥60 years (M = 67.9 ± 4.2) were asked to complete a questionnaire via telephone calls, allowing us to identify sociodemographic and health-related factors influencing the daily medications consumption. Our findings revealed that all of the participants were receiving medications; 60.2% of them receive at least 1 to 3 drugs per day (301/500). The most commonly used medications included antihypertensive drugs and analgesics (51.0% and 46.0%, respectively). Taking into account clinical conditions, independent predictors of receiving over 3 medications per day turned out to be (1) coronary artery disease (OR = 6.77; CI 95%, 2.86–16.1), (2) diabetes (OR = 3.23, CI 95%, 1.75–5.95), (3) asthma (OR = 4.87, CI 95%, 2.13–11.1), (4) heart failure (OR = 3.38, CI 95%, 1.59–7.19) and (5) gastroesophageal reflux disease (OR = 1.93, CI 95%, 1.03–3.62). Participants suffering from depression were more likely to take drugs for hypertension (OR = 1.70, CI 95%, 1.04–2.78), while those with anxiety and social loneliness took more painkillers (OR = 2.59, CI 95%, 1.58–4.26 and OR = 2.08, CI 95%, 1.38–3.13, respectively). The most significant sociodemographic factors increasing the drugs intake among the population included in our study were high body mass and subsequent increased BMI values (OR = 2.68, CI 95%, 1.50–4.77). Furthermore, living in a city with over 400,000 inhabitants increased the likelihood of taking antidepressants (OR = 2.18, CI 95%, 1.20–3.94). Our study revealed factors increasing the risk of excessive medications intake and hence, increased susceptibility to some iatrogenic diseases among the elderly population. These factors should be considered by primary care physicians while prescribing appropriate drugs to elderly patients.

How Diabetes and Other Comorbidities of Elderly Patients and Their Treatment Influence Levels of Glycation Products

Medical care for geriatric patients is a great challenge, mainly due to various overlapping deficits relevant to numerous coexisting diseases, of which the most common are diabetes mellitus and atherosclerosis. In the case of diabetes, the glycation process is intensified, which accelerates atherosclerosis development and diabetic complications. Our goal was to investigate the relationship between the classical biochemical parameters of diabetes and atherosclerosis, as well as parameters which may indicate a nephropathy, and the parameters strictly related to glycation, taking into account the pharmacological treatment of patients. Methods: We analyzed the patients’ serum concentrations of fluorescent glycation product—pentosidine, concentrations of soluble receptors for advanced glycation products (sRAGE), lipoprotein receptor-1 (LOX-1), galectin 3 (GAL3), scavenger receptor class A (SR-A), and scavenger receptor class B (SR-BI), as well as the level of lipid peroxidation and free amine content. Among the identified correlations, the most interesting are the following: sRAGE with triglycerides (r = 0.47, p = 0.009), sRAGE with SR-BI (r = 0.47, p = 0.013), SR-BI with LOX-1 (r = 0.31, p = 0.013), and SR-BI with HDL (r = −0.30, p = 0.02). It has been shown that pentosidine and reactive free amine contents are significantly higher in elderly patients with ischemic heart disease. Pentosidine is also significantly higher in patients with arterial hypertension. Malondialdehyde turned out to be higher in patients with diabetes mellitus type 2 that was not treated with insulin or metformin than in those treated with both medications (p = 0.052). GAL3 was found to be lower both in persons without diabetes and in diabetics treated with metformin (p = 0.005). LOX-1 was higher in diabetic patients not treated with metformin or insulin, and lowest in diabetics treated with both insulin and metformin, with the effect of metformin reducing LOX-1 levels (p = 0.039). Our results were the basis for a discussion about the diagnostic value in the clinical practice of LOX-1 and GAL3 in geriatric patients with diabetes and also provide grounds for inferring the therapeutic benefits of insulin and metformin treatment.

Salivary Melatonin Changes in Oncological Patients: A Systematic Review

Melatonin is known as a regulator of circadian sleep and waking rhythm. This hormone secreted by the pineal gland also has protective, oncostatic, and antioxidant properties. This systematic review was designed to answer the question “Is there a relationship between salivary melatonin changes and oncological diseases?”. Following the inclusion and exclusion criteria, ten studies were included, according to PRISMA statement guidelines. In all included studies, the diagnostic material was unstimulated whole saliva, in which the melatonin changes were determined by different laboratory methods. Most studies concerned changes in melatonin levels in patients with brain tumours due to a direct effect on the circadian rhythm centres. Other studies focused on disorders of melatonin secretion and its inclusion as a diagnostic marker in patients with prostate cancer and oral squamous cell carcinoma. The association between melatonin changes and sleep quality and chronotype in patients with newly diagnosed lung cancer and lymphoma survivors was also investigated. In conclusion, our systematic review may suggest trends for melatonin secretion alterations in oncological patients. However, due to the significant heterogeneity of the included reports, it is not possible to clearly determine a link between changes in salivary melatonin levels and the oncological diagnosis.

Identification of Barriers Limiting the Use of Preventive Vaccinations against Influenza among the Elderly Population: A Cross-Sectional Analysis

Older adults are at a high risk of experiencing severe complications of influenza. Receiving a vaccination is a beneficial strategy to prevent the disease and reduce the severity of influenza illnesses. This cross-sectional questionnaire-based study aimed to evaluate the influence of sociodemographic, clinical, and mental parameters as well as other potential risk factors on refusal to vaccinate against influenza among the elderly population in Poland. Furthermore, due to the prevailing COVID-19 pandemic, we put efforts into finding any statistical correlations between the fear of COVID-19 infection in patients and their attitudes toward receiving an influenza vaccination. The study was conducted in November−December 2020 in Poland on a representative nationwide sample of 500 individuals aged > 60. Of the respondents, 62 (12.4%) and 51 (10.2%) underwent influenza vaccination in 2019 and 2020, respectively. Out of ten different factors analyzed in this study, three were significantly associated with attitudes towards influenza vaccination. Participants with net income below the national average of PLN 3000 (OR = 2.37, CI 95% [1.26−4.47]), compared to those earning more than PLN 3000, had significantly higher odds of having a negative attitude towards influenza vaccination. Furthermore, respondents with <174 cm height (OR = 2.56, CI 95% [1.51−4.33]) and those with strong fear of COVID-19 infection (OR = 1.65, CI95% [1.02−2.66]) were also more likely to refrain from influenza vaccination. We believe the identification of factors limiting the willingness to receive influenza vaccination is an effective way to help clinicians focus their efforts on educating the groups of patients with the highest odds of refusing to receive the vaccine. Moreover, it may aid the design and enforcement of national solutions or the implementation of novel legislative measures and preventive programs, increasing public confidence and promoting vaccination, especially among groups at high risk of developing this disease.

COVID-19 Vaccination Acceptance among Healthcare Workers and General Population at the Very Beginning of the National Vaccination Program in Poland: A Cross-Sectional, Exploratory Study

The aim of the study was to assess the acceptance level of COVID-19 vaccination among healthcare workers (HCW) and the general population in Poland at the start of the national COVID-19 vaccination program from 18-31 December 2020. A cross-sectional anonymous survey was conducted in a group of 1976 people: 1042 health professionals and 934 non-medical professionals using an on-line questionnaire. The most skeptical about the COVID-19 vaccine were students of non-medical faculties, non-medical professions, and administrative-technical health service staff (26.2%, 38.7% and 41.2%, respectively). The most positive attitude to vaccination was reported by doctors, medical students and pharmacists (80.6%, 76.9% and 65.7%, respectively). Doctors (64.7%) and medical students (63.7%) most often declared confidence in vaccines compared to nurses (34.5%). Distrust about vaccine safety was declared by nurses (46.6%) and pharmacists (40.0%). HCW encouraged others to vaccinate more eagerly (65.8%) than non-medical professions (28.3%). Thus, a considerable proportion of HCW in Poland expressed concern about vaccines just prior to the beginning of the COVID-19 immunization program. The significant decrease in the willingness to vaccinate observed in Poland towards the end of 2021 must be considered in the light of the serious COVID-19 vaccination hesitancy in the Polish population.

Sarcopenia Identification during Comprehensive Geriatric Assessment

Comprehensive geriatric assessment (CGA) is a multidimensional diagnostic process enabling evaluation of elderly patients' physical and mental health status that implies implementation of the management targeted on the preservation of functional independence. Sarcopenia is a common but often underdiagnosed geriatric syndrome associated with increased likelihood of functional dependence and mortality risk. The main objectives of the study were the evaluation of sarcopenia prevalence in the patient group subjected to CGA with the upgraded EWGSOP2 algorithm considering muscle strength as the key criterion and usage of bioimpedance (BIA) muscle mass assessment. The study group consisted of 101 patients (76 women and 25 men) admitted for planned CGA to the Geriatrics Department of Wroclaw University Hospital. A diagnosis of sarcopenia was made according to the EWGSOP2 protocol. Body composition was determined with the bioimpedance technique. Functional status was assessed with ADLs from the VES-13 scale and additional questions. Sarcopenia was diagnosed in 16.8% of the study participants. Sarcopenic individuals presented worse functional status and impaired social activity. Muscle strength, gait speed and muscle mass below cut-off values were associated with dependence found in ADLs. Results showed that sarcopenia is a common impairment correlated with worse functional status and vulnerability to adverse outcomes. BIA can be treated as an accessible and accurate technique for muscle mass measurement in screening for sarcopenia, and the EWGSOP2 algorithm should be an essential part of the routine CGA procedure.

The Assessment of Fear of COVID-19 among the Elderly Population: A Cross-Sectional Study

The prevailing COVID-19 pandemic has dramatically affected the mental health and well-being of individuals. This cross-sectional study aimed to assess the perceived fear of COVID-19 among older adults in Poland and identify subpopulations with the highest risk of potential mental health disorders. The study was conducted in November–December 2020 on 500 people aged ≥60 years (mean M = 67.9, standard deviation SD = 4.2). In order to collect information on participants’ characteristics and COVID-19-related information, they were asked to complete a questionnaire based on recorded telephone calls. Perceived fear of COVID-19 was measured using Fear of COVID-19 Scale (FCV-19S), which ranges from 7 to 35. Multiple linear regression was performed to identify factors associated with the perceived fear of COVID-19. Our results showed that the highest level of fear of COVID-19 infection was observed among women (p = 0.025) and patients taking anticoagulants (p = 0.004). Moreover, older adults with higher anxiety levels were more likely to be fearful of COVID-19 (according to the GAS-10 scale; p < 0.001). These findings may help policy makers and healthcare workers to adapt and implement better mental health strategies to help the elderly fight fear and anxiety during the prevailing pandemic.

Disturbances in the intraventricular conduction system in teenagers with type 1 diabetes. A pilot study

Body Surface Potential Mapping (BSPM) is a multi-electrode synchronous method for examining electrocardiographic records on the patients' body surface that allows the assessment of changes in the heart conduction system. The aim of the study was to visualize and evaluate changes in the intraventricular system in adolescents with T1D.

PATIENTS AND METHODS

Inclusion criteria: age > 12 years, T1D duration >3 years, HbA1c >8%.

EXCLUSION CRITERIA

diagnosis of autonomic neuropathy, heart structural defects, heart failure. BSPM data were processed into map plotting to illustrate differences in ventricular activation time (VAT, isochron lines).

RESULTS

33 teenagers (20 boys), mean age 15.0 ± 2.1 years, T1D from 6.8 ± 4.1 years were included. Mean HbA1c was 9.6 ± 2.0%. In the standard ECG recording abnormalities were not present. The distribution of isolines on the group-mean map plotted for T1D patients only initially resembles the course of isolines on the group-map for normal subjects (N = 30), in whom the electrical impulse stimulating the heart ventricles passes through the atrio-ventricular node, then symmetrically excites the branches of His bundle and finally the Purkinje fibers. In T1D patients, after proper onset of intraventricular stimulation, the isolines reflecting the both ventricles reach higher time values, which indicates problems in the propagation of the ventricular depolarization.

Erectile Dysfunction in Men Burdened with the Familial Occurrence of Coronary Artery Disease

Erectile dysfunction (ED) and coronary artery disease (CAD) share common risk factors, some of which have genetic backgrounds, while others may be stimulated by family lifestyle. We investigated the impact of the familial occurrence of CAD on the presence of ED and the presence of classic risk factors for ED in men with CAD. This cross-sectional observational study involved 751 men with CAD who were subjected to cardiac rehabilitation. Overall, 75.63% of the men had ED. CAD was diagnosed in 39.28% of the studied men’s relatives. ED was less frequent in the men with familial CAD than in those without (71.53% vs. 78.29%). Similar relations were observed for the presence of CAD in parents (70.43% vs. 78.34%) and the father (69.95% vs. 77.46%). The International Index of Erectile Function 5 score was significantly higher in patients with familial CAD (median (interquartile range); 17 (12–22) vs. 16 (10–21); p = 0.0118), in parents (18 (12–22) vs. 16 (10–20); p = 0.021), and in the father (18 (12–22) vs. 16 (10–21); p = 0.0499). Age and education minimized the effect of familial CAD. Familial CAD increased the incidence of hypertension, dyslipidemia, and smoking but not sedentary lifestyle. Despite the higher prevalence of selected risk factors for ED in men with familial CAD, a higher incidence of ED was not observed.

Rapid Determination of Sufentanil in Human Plasma by UHPLC-QqQ-MS-MS

This paper presents a rapid, sensitive and precise method developed and validated for the quantification of sufentanil in biological samples using ultra-performance liquid chromatography coupled with QqQ-MS-MS. Plasma samples were extracted with simple and fast liquid-liquid extraction (ethyl acetate, pH 9). Calibration curve showed linearity in the concentration range of 0.005-30 µg/L. The lower limit of quantification was 0.010 µg/L. The most important method features are low lower limit of quantification value, simple plasma extraction and small sample volume. This method is suitable not only for evaluation of the pharmacokinetics, toxicology, bioavailability and clinical pharmacology of sufentanil but also for the detection and identification of this compound in human plasma samples for forensic purposes.

Selected clinical parameters and changes in cardiac morphology and function assessed by magnetic resonance imaging in patients with rheumatoid arthritis and ankylosing spondylitis without clinically apparent heart disease

BACKGROUND

The aim of the study was to assess the relationship between the occurrence of rheumatoid arthritis (RA) and ankylosing spondylitis (AS) and the cardiac magnetic resonance (CMR) changes in people without clinically overt heart disease.

METHODS

The study group consisted of 74 people (48.81 ± 11.35 years): 29 patients with RA, 23 patients with AS and 22 people from control group. Blood samples were taken to assess laboratory parameters, disease activity was determined using activity scales, and CMR was performed.

RESULTS

It was shown that the factors independently related to higher left ventricular mass index are AS occurrence, human B27 leukocyte antigen occurrence, higher neutrophil gelatinase-associated lipocalin concentration (NGAL) and higher body mass index (BMI). The lower right ventricular ejection fraction is result of an independent effect of RA, AS and higher NGAL. RA presence, methotrexate use, higher rheumatoid factor titer, higher NGAL, older age and higher BMI should be considered independent risk factors for greater left ventricular myocardium water content. RA occurrence, AS occurrence, type 2 diabetes occurrence and a higher C-reactive protein concentration can be independently associated with a higher probability of non-ischemic left ventricular myocardium injury. Larger pericardial fluid volume is result of an independent effect of higher NGAL, higher anti-cyclic citrullinated peptide antibodies titer and higher DAS28 disease activity index. Use of steroids is protective factor against larger volume of pericardial fluid.

CONCLUSIONS

RA and AS in people without clinically apparent heart disease are associated with the occurrence of adverse changes in CMR. Key Points •RA and AS in people without clinically apparent heart disease are associated with the occurrence of adverse changes in CMR.. •The independent risk factors for higher LVEF are AS occurrence, human B27 leukocyte antigen occurrence, higher NGAL concentration and higher BMI.. •RA presence, methotrexate use, higher RF, higher NGAL, older age and higher BMI are independent risk factors for higher LV T2 ratio.. •RA occurrence, AS occurrence, type 2 diabetes occurrence and a higher CRP are independently associated with a higher risk of non-ischemic LV myocardium injury..

Diagnosis of hypogonadism in patients treated with low energy shock wave therapy for erectile dysfunction: a narrative review

Several methods of treatment of erectile dysfunction (ED) are offered with low energy shock-wave therapy (LESWT) gaining increasing attention. Reports have documented that LESWT stimulates tissue neovascularization, proliferation and differentiation of endothelial cells, and production of nitric oxide - all can improve the condition of erectile tissue. However, the overall and sexual condition of men deteriorates with age which is linked with a constant decrease in testosterone concentration. A higher risk of sexual health disorders and reduced physical fitness correlates with a testosterone concentration of <12 nmol/L. Such patients may require testosterone replacement therapy. We conducted a target literature review to investigate whether testosterone concentration is taken into account in studies on the use of LESWT in the treatment of ED. We found that most studies did not provide any information on testosterone status. Only 8 of 25 studies examined showed values of testosterone concentrations. Only one of these analyses checked the relationship between the efficacy of LESWT and testosterone concentration. As a result, meta-analyses published to date may not show the full value of LESWT in the treatment of ED. We conclude that in the light of the significant role testosterone plays in the process of an erection and the mechanism of LESWT action, it can be recommended to examine testosterone concentration and to diagnose hypogonadism during the qualification of patients to studies on LESWT efficacy. Moreover, the effectiveness of LESWT in relation to the current testosterone concentration should also be further investigated.

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.

Effects of cigarette smoke on Holter ECG recordings in patients with arterial hypertension. Part 2: Parameters of heart rate turbulence

The studies aimed at evaluation of cigarette smoke effect on heart rate turbulence (HRT) in patients with arterial hypertension (AH). 223 consecutive individuals were qualified to the studies. The following groups of patients not suffering from other disease which may affect HRT were distinguished: 1--patients with AH (n=145); 2--patients without AH (n=48). In group 1 the following patient subgroups were studied: A--active smokers (n=42), B--non-smokers exposed to cigarette smoke (n=30), C--non-smokers not exposed to tobacco smoke (n=34), D--former smokers who had quit smoking (n=26). In every participant HRT analysis was conducted. Subgroup A manifested significantly higher values of TO and lower values of TS as compared to analogous values obtained in subgroups B-D. Subgroups B and D were characterized also by significantly higher values of TO and lower values of TS as compared to subgroup C. Active and passive cigarette smoking were found to represent independent risk factors for an abnormal HRT.

CONCLUSION

Both active and passive exposure to tobacco smoke induces causes abnormal HRT in patients with arterial hypertension.

Pyoderma gangrenosum-like skin changes after subcutaneous administration of low molecular weight heparin

In the present report, we would like to comment a case of patient with diabetes mellitus type 2 manifesting the rare complication of heparin subcutaneous administration in a form of pyoderma gangrenosum-like skin changes which were induced probably by an immune-modulating activity of heparin.

Effects of cigarette smoke on Holter ECG recordings in patients with arterial hypertension. Part 1: Time domain parameters of heart rate variability

This report was intended to evaluate the effect of cigarette smoke on heart rate variability (HRV) in patients with arterial hypertension (AH). 223 individuals were qalified to the studies. The following groups of patients not suffering from other disease which may affect HRV were delineated: 1 - patients with AH (n=145); 2 - patients without AH (n=48). In group 1 the following patient groups were studied: A - active smokers (n=42), B - non-smokers exposed to cigarette smoke (n=30), C - non-smokers not exposed to tobacco smoke (n=34), D - former smokers (n=26). A time domain HRV analysis was carried out. Group 1 versus group 2 manifested significantly lower mean values of most parameters in the HRV time domain analysis. Subgroups A, B and D versus subgroup C also exhibited significantly lower mean values of most parameters in the HRV time domain analysis. Active cigarette smoking and passive exposure to tobacco smoke represented independent risk factors for a decreased HRV.

CONCLUSIONS

Active and passive exposure to cigarette smoke decreases HRV in hypertensive patients.