[Patients' awareness of the threat of taking antithrombotic and antiplatelet agents due to cardiological recommendations].

Introduction: Nowadays, antithrombotic and antiplatelet agents are widely used in cardiology. Both agents, apart from their therapeutic benefits, have many adverse effects. The main aim of the study was to assess the awareness and knowledge of side effects and possible complications in patients taking antithrombotic and antiplatelet agents due to cardiological recommendations. Material and methods: A sample of 180 patients (mean age 65 years) was studied. A diagnostic survey based on a questionnaire prepared by the researchers was used for measurements. Results: The results indicated that among antithrombotic and antiplatelet agents taken by patients the most often used were: acetylsalicylic acid (140 patients) and clopidogrel (64 patients), while acenocoumarol derivatives were taken by 25 patients. When asked whether the patient obtained information about the side effects of drugs 51% of patients acknowledged obtaining information, 22% of patients denied that they were given such information, and 27% of patients admitted that they had forgotten whether they were informed about side effects. 23% of patients described their knowledge of the effects of drugs as wide, 57% of patients as basic, and 20% of patients admitted a lack of knowledge in that area. 25% of patients knew the threats of sudden discontinuation of treatment. 81% of patients could not describe management in the case of missing a dose of the drug. Conclusions: The results suggest that in patients on antithrombotic treatment the state of knowledge about complications, side effects and interactions of drugs is insufficient. The methods and scope of education are inadequate. Considering the widespread use of antithrombotic treatment, anticoagulation clinics should be established.

[Study of depressiveness with Beck Depression Inventory in patients with cardiac arrhythmias]. / Badanie depresyjnosci skala depresji Becka u pacjentów z zaburzeniami rytmu serca.

INTRODUCTION: Atrial fibrillation belongs to the group of supraventricular arrhythmias. The episode begins with anxiety about the loss of health or life. Anxiety is accompanied by depressive disorders. The aim of this work was to study the intensity of depression in patients with atrial fibrillation. MATERIAL AND METHODS: We used Beck Depression Inventory in 52 patients with atrial fibrillation hospitalized at the Department of Internal Medicine of the Poviat Hospital in Bialogard. Correlations between the intensity of depression and age, gender, and education level were determined. RESULTS: The intensity of depression depended on age, gender, and education level. Mild depression was more common in women, moderate in men, and was very severe in 2 women. Patients between the age of 61 and 80 years and with incomplete primary and vocational education presented with all forms of depression. CONCLUSIONS: The intensity of depression correlates with episodes of atrial fibrillation and depends on such factors as age, gender, and education level (p < 0.05). Effective therapy of atrial fibrillation may help reduce the intensity of depression.

[Is autosomal dominant polycystic kidney disease associated with asymptomatic bacteriuria?]. / Czy u chorych z autosomalna dominujaca wielotorbielowatoscia nerek wystepuje bakteriomocz bezobjawowy?

UNLABELLED: Urinary tract infections (UTIs) are a common complication in patients with autosomal dominant polycystic kidney disease (ADPKD). Asymptomatic bacteriuria (AB) is a factor predisposing to UTI in other populations. The aim of the study was to determine whether AB is more frequent in a group of ADPKD patients with normal kidney function and no diabetes than in a healthy control group. MATERIAL AND METHODS: A group of 49 ADPKD patients (19 men and 30 women) with normal kidney function (creatinine level < 1.35 mg/dl) and no diabetes, with an average age of 35.9 +/- 11.1 years was compared with a group of 50 healthy controls (22 men, 28 women) with similar age (36.7 +/- 9.2 years). All subject were evaluated using medical history and physical examination, urine culture, urinalysis (biochemical and morphological), kidney ultrasonography, oral glucose tolerance test (with 75 g of glucose) and serum creatinine testing. RESULTS: UTIs were significantly more frequent in medical history of ADPKD patients than in control group (26% vs. 0%, p < 0.001). Asymptomatic bacteriuria was found in 2% of ADPKD patients and in 4% of control group (p = 0.69). The presence of protein in urinalysis was observed in 6% of ADPKD and in none of the control patients. Other urine measurements like pH, specific gravity, and morphological examination were normal and did not substantially differ between groups. The kidneys of ADPKD patients were significantly longer than in control group (p < 0.001). CONCLUSIONS: Asymptomatic bacteriuria is not present more frequently in ADPKD patients with normal kidney function and no diabetes, than in healthy people.

[Measurement of anxiety with C.D. Spielberger's test in patients with cardiac arrhythmias]. / Badanie nasilenia leku testem C.D. Spielbergera u pacjentów z zaburzeniami rytmu serca.

INTRODUCTION: Atrial fibrillation is a common supraventrical arrhythmia. The onset of fibrillation is marked by fear of loss of health or life. Symptoms of depression occur concurrently. This study was undertaken to measure anxiety in patients with atrial fibrillation grouped according to gender, age, and education. MATERIAL AND METHODS: The test anxiety inventory of C.D. Spielberger was administered to 52 patients aged 41 to 80 years, treated for atrial fibrillation at the Internal Ward of the District Hospital in Bialogard. RESULTS: Anxiety as a state was observed more frequently in males and in patients with vocational and secondary education. Anxiety was not a trait of atrial fibrillation. Psychotherapeutic interventions used in cardiac rehabilitation are not recommended in atrial fibrillation. However, relaxation techniques could be of benefit in reducing the intensity of anxiety as a state.

[Gastroesophageal reflux disease among patients suffering from coronary artery disease]. / Choroba refluksowa przelyku u osób z choroba niedokrwienna serca.

INTRODUCTION: In recent years, the increasing frequency of gastroesophageal reflux disease (GERD) occurrence has been observed. Gastroesophageal reflux disease may take the form of so called 'heart mask' (i.e., chest pain) imitating ailments typical for the myocardial ischemia. The aim of this work was to evaluate frequency of GERD symptoms and the oesophagitis among patients suffering from angiographically confirmed coronary artery disease. The patients mentioned above were ordered to undergo CABG. MATERIAL AND METHODS: 134 coronary artery disease (CAD) patients were observed. All patients underwent collection of medical history and gastrointestinal endoscopy. RESULTS: Gastroesophageal reflux disease symptoms were found in 46 patients diagnosed with CAD what constitutes 34% of the total number of patients (28.3 vs. 3.4%, p = 0.00006). It has to be mentioned that oesophagitis was found more often among patients suffering from GERD (i.e., among 24% of the total number of patients). According to the Los Angeles classification, type A of the reflux oesophagitis occurred more frequently than type B did (A = 15.3%, B = 10.9%). Barrett's oesophagus had been observed among 5.5% ofpatients. Other complications of GERD had not been found. It is worth to emphasize that there was a significant statistical correlation between GERD, hiatal hernia, myocardial infarction and smoking. CONCLUSIONS: Patients suffering from myocardial ischemia may often have GERD symptoms that are not accompanied by injury of oesophageal mucosae in most cases. Confirmation and explanation of the observed relation between the presence of hiatal hernia and infarction underwent require further research.

[Influence of gastric juice pH on the metabolism of vitamin C in gastric mucosa and juice]. / Wplyw pH soku zoladkowego na metabolizm witaminy C w blonie sluzowej i swietle zoladka.

UNLABELLED: Vitamin C is present as ascorbic acid (Asc) with antioxidative properties and as its oxidation product dehydroascorbic acid (dAsc). Asc is actively transported from blood to gastric juice where it prevents formation of carcinogenic nitrosamines and protects mucosa from reactive oxygen species. Another important function of gastric mucosa is proton pump-dependent secretion of hydrochloric acid. The pump maintains high pH gradient between gastric juice and plasma. The aim of the work was to analyse relations between gastric juice pH and concentrations of Asc and dAsc in plasma, gastric mucosa and juice as well as other factors modifying metabolism of vitamin C and function of gastric mucosa. MATERIALS AND METHODS: 31 patients were subjected to diagnostic endoscopy due to dyspepsia. Concentrations of Asc and dAsc were measured in plasma, gastric mucosa and juice with HPLC method. pH of gastric juice was determined. Histopathology examination of mucosa and urease test for Helicobacter pylori were performed. Data concerning dyspeptic symptoms and used drugs, including vitamin C preparations, were collected. RESULTS: Patients taking vitamin C preparations had significantly lower gastric juice pH values than the others (median 2.2 vs 5.4; p < 0.01). Treatment with vitamin C preparations was also associated with higher Asc concentrations in gastric juice (median 16.6 vs. 1.8 micromol/L; p < 0.09); the difference was statistically significant in the subgroup of patients with gastritis (median 16.6 vs. 0.1 micromol/L; p < 0.04). Strong negative correlations of pH with Asc (Rs = -0.67; p < 0.001) and dAsc (Rs = -0.48; p < 0.01) concentrations were observed in gastric juice. Positive correlation of pH and relative dAsc content expressed as percent of total vitamin C concentration in gastric juice was also statistically significant (Rs = +0.48; p < 0.05). CONCLUSIONS: Performance of the proton pump and vitamin C metabolism in the stomach are closely mutually connected. Modification of hydrochloric acid secretion may affect gastric juice vitamin C concentration. Potentially disadvantageous influence of antisecretory drugs on the mechanisms of antioxidative protection in the stomach needs further investigation.

[Is it necessary to treat Helicobacter pylori infection in patients with end-stage renal failure and in renal transplant recipients?]. / Czy nalezy leczyc zakazenie Helicobacter pylori u chorych w okresie skrajnej niewydolnosci nerek i po przeszczepieniu nerek?

Uraemic patients frequently complain of gastrointestinal ailments. There are a lot of factors responsible for the occurrence of these symptoms. It is considered--among other things--that high level of urea in gastric juice and hypergastrinaemia contribute to the damage of stomach and duodenum mucosa. Does H. pylori infection also produce pathological changes within upper gastrointestinal tract in these patients? The aim of the study was to determine the prevalence of H. pylori infection and macroscopic and microscopic estimation of oesophagus, stomach and duodenum mucosa in haemodialysis patients and renal transplant recipients. A total of 39 patients were taken under investigation: 27 among them were treated with haemodialyses and 12 were after kidney transplantation. In all patients upper gastrointestinal endoscopies were performed with collection of biopsy specimens for histological analysis and a urease test. Serological examinations were carried out in order to detect anti-CagA H. pylori antibody. In summary, we found that prevalence of H. pylori infection in uremic patients on chronic haemodialysis and renal transplant recipients was significantly lower than that in patients with normal renal function. This may be a consequence of medication and/or protection by a high urea concentration. Elevated blood urea seems to correlate with a high prevalence of gastroduodenal mucosal lesions.

[Gastroesophageal reflux disease--diagnostic and therapeutic problems]. / Choroba refluksowa przelyku--problemy diagnostyki i terapii.

Endoscopy is the method commonly used in the diagnosis of GERD (Gastroesophageal Reflux Disease). Although it is not rare that despite of typical clinical symptoms of the disease, investigation doesn't show any changes. The aim of endoscopy is to monitor pathological changes occurring in GERD--severe inflammation of the esophagus, strictures, ulcers and Barrett's esophagus. The possibility of histopathological assessment of mucosal biopsy, allows us to find dysplasia or metaplasia changes. Proton pump inhibitors (PPI) are first choice drugs in GERD and show higher efficacy compared to H2 blockers and prokinetic drugs.