Patients with diabetes mellitus have better lipid profile results compared to the controls - a retrospective study on a group of patients hospitalized due to pulmonary embolism.

Background: Pulmonary embolism is a clinical manifestation of venous thromboembolism (VTE), also comprising deep vein thrombosis. It is considered to be a consequence of environmental and genetic factors. The number of predisposing risk factors is high. Some authors view VTE as a part of the cardiovascular disease continuum and suggest that cardiovascular disease risk factors such as the metabolic syndrome or diabetes mellitus may predispose to VTE. Aim: The analysis of patients hospitalized in the department of cardiology due to pulmonary embolism and a multifactorial comparison of 2 groups of patients i.e. with and without diabetes mellitus. Patients and Methods: A retrospective analysis of 11435 patient medical records from a 7-year period was performed. Patients with confirmed pulmonary embolism were enrolled for further evaluation. Sixty seven patients (36 women and 31 men), aged 70.3±13.3 (age range: 30- 93) were divided into two groups i.e. patients with and without diabetes. The statistical analysis of the obtained results was performed using SPSS 21 Software. Results: Statistically significantly higher total, LDL, and HDL cholesterol concentrations were observed in patients without diagnosed diabetes. Similar significant differences were not observed for other cardiovascular risk factors except for hypertension and obesity which was more frequent in diabetic patients. Conclusions: In patients with pulmonary embolism the prevalence of diabetes was related to lower total, LDL and HDL cholesterol concentrations. The differences between the groups may be explained by more intensive medical surveillance in patients with previously diagnosed diabetes.

The impact of gender on the frequency of syncope provoking factors and prodromal signs in patients with vasovagal syncope.

Introduction: According to the ESC guidelines, syncope is a transient loss of consciousness caused by transient, general cerebral hypoperfusion, characterized by rapid onset, short duration and spontaneous recovery. Objectives: The aim of the study was a comparative analysis of syncope provoking factors and prodromal signs in patients with vasovagal syncope with consideration given to gender. Materials and Methods: We investigated 80 patients, aged 18-74 years with previously diagnosed vasovagal cause of syncope. Special attention was paid to the frequency of triggering factors and prodromal signs. Results: In the studied group the mean age at first syncope was significantly lower in women (23.2±10.7) as compared to men (30.7±17.4). The mean total number of syncopal and presyncopal episodes was significantly higher in women (13.3±11.0 vs. 7.8±6.6; 26.6±12.9 vs. 13.8±6.9). In the group of men syncopal episodes were more frequent after urination and defecation. The remaining circumstances related to syncope were more prevalent in women, but only the occurrence of a syncopal episode during walking achieved statistical significance. All the prodromal signs that were analysed occurred more frequently in the group of women compared to men. Statistical significance was achieved for the analysed signs such as generalized weakness, dyspnea, heart palpitations, cold sweats, feeling of cold or heat, visual disturbances, tinnitus, headache. Conclusions: Syncope provoking factors and prodromal signs occur more frequently in women.

[Night work and shift work - effects on the health of workers].

Number of shift workers increases in developed as well as in developing countries every year and equals 15- 20% of total amount of working people in Europe, 20% of total count of workers in United States of America, 6-32% in Asian countries and 8.1% workers in Poland. This type of employment is connected with such sectors of economy as medical care, industry, mining, transportation, communication and hospitality. The literature review analyses health effects of shift work and night work in the area of gastroenterology, circulatory system, oncologic diseases, neuropsychiatric and sleep disorders. In summary shift and night work have negative impact on human health. Further investigations analyzing impact of shift and night work are needed.

[Vitamin D blood levels of students in grades IV-Vl of primary schools in Katowice]. / Stezenie witaminy D we krwi uczniów klas IV-VI szkól podstawowych w Katowicach.

UNLABELLED: Results of studies conducted around the world show a drastic deficiency vitamin D in almost all populations, and the strongest in the group of children and the elderly. The aim of this study was to evaluate the concentration of vitamin D in children aged 10-12 years. MATERIAL AND METHODS: The study included 42 children aged 10-12 years 24 girls and 18 boys).The obtained data were statistically analyzed using STATISTICA 10 (StatSoft Inc. Dell) RESULTS: Half of the subjects (n = 21) had levels of vitamin D i not greater than 14.872 ng/ml (median). The median concentrations of vitamin D was higher in the studied group of boys than girls and amounted to 16.54 vs 14.02. Most patients (n = 18; 42.8%) had levels of vitamin D between 10 and 20 ng / ml (deficiency),7 persons (16.7%) had a severe deficiency (≤10 ng/ml), a significant number of patients (n = 15; 35 7%) had a slight deficiency of vitamin D called moderate hypovitaminosis. Only two individuals (4.8%) had concentrations in the range defined as optimum. CONCLUSIONS: The results of the present study show a deficiency of vitamin D in the study group children aged 10 - 12 years.

[Pathogenesis of tricuspid valve regurgitation in patients with implanted of right-ventricular electrode]. / Patogeneza niedomykalnosci zastawki trójdzielnej u pacjentów po implantacji elektrody prawokomorowej.

Permanent pacemakers could provoke or enhance preexisting tricuspid valve regurgitation. Pacemaker electrode implantation provokes local inflammatory process and subsequent permanent tissue remodeling, particularly in area of neighboring valve apparatus. As a consequence valve regurgitation may occur. It is supposed that valve perforation and right ventricle contraction asynchrony caused by right ventricle apex stimulation may lead to tricuspid valve regurgitation. Presented work shows current literature review according this topic.

[Influence of right ventricular pacing on tricuspid regurgitation grade--the current state of knowledge]. / Wplyw stymulacji prawokomorowej na stopien niedomykalnosci zastawki trójdzielnej--aktualny stan wiedzy.

Tricuspid valve regurgitation (TR) caused by permanent pacemaker implantation was first described in the eight decade of XX century, however dynamical increase in frequency of pacemaker implantation makes this topic of growing importance. Pacemaker electrode in the right part of the heart could intensify TR, but this dependence is still not clearly understood. Available studies in the most of cases are not related on uniform criteria of TR, what provides difficulties in the analyses. Additional difficulty provides the fact that TR occurs in a high percentage of healthy people. Current literature shows, that risk factors for TR worsening are patients' older age and previously diagnosed valve pathologies. Results of studies concerning influence of number, type, or location of the electrode in the heart on the TR severity are unclear. This article presents current literature review regarding influence of right-sided pacing on the frequency of TR.

[Signification of NT-proBNP in the differential diagnosis of syncope in adults]. / Znaczenie NT-proBNP w diagnostyce róznicowej omdlen u osób doroslych.

Syncope is a transient loss of consciousness, which is the result of global brain hypoperfusion, characterized by rapid onset, short duration, and spontaneous complete resolution. Syncope is a common clinical problem due to its complex, multi-causal etiology, not completely understood pathogenesis and potential complications. Diagnosis of syncope is often associated with the implementation of many medical tests. In the recent years, the role of determining the concentration of NT-proBNP in the differential diagnosis of syncope has been highlighted. Aims of the study was analysis of NT-proBNP concentrations in patients with cardiogenic syncope in comparison to patients with neurogenic syncope and determination of the threshold value of NT-proBNP to differentiate cardiac and neurogenic syncope and to determine its sensitivity and specificity. The study included 160 pts (64 man, 96 women), aged 18 - 77 yrs (mean age 50,6) with a reflex syncope (group I) or cardiac syncope (group II). To determine the etiology of syncope, collected were: medical history for symptoms and circumstances of the syncope, measurements of blood pressure, resting ECG recording, cardiac echocardiography, and the concentration of NT-proBNP levels. Results: the group I included 80 pts (29 men, 51 women), aged 18 - 72 yrs (mean age 41.2). Group II included 80 pts (35 man, 45 women), aged 38 - 77 yrs (mean age 62.1). The assessment of concentrations of NT-proBNP showed significantly higher levels in group II than group I (467.6 +/- 227.4 vs 64.1 +/- 59.1; p <0.0001). In patients with arrhythmias and conduction abnormalities, the levels of NT-proBNP were higher in comparison to those without such disorders (364 +/- 249 vs. 171 +/- 209 pg/ml, p < 0.001). It was found that the concentration of NT-proBNP at 230.6 pg/ml might be a cut-off point that allows the prediction of cardiogenic cause of syncope with 96% specificity, 92% sensitivity and 93% negative predictive value. Conclusions: 1. The concentration of peptide NT-proBNP patients with reflex syncope. 2. It was shown that the cut off concentration of the NT-proBNP equal 230.6 pg/ml is characterized by the high sensitivity, specificity, and negative predictive value in determining the etiology of syncope.

The role of NT-proBNP in the diagnostics and differentiation of cardiac and reflex syncope in adults: relative importance to clinical presentation and medical examinations.

PURPOSE: The aim of this study was to assess the clinical significance of N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations in the differentiation of patients with cardiac and reflex syncope. METHODS: The study included a group of 100 patients (56 women, 44 men), aged 18-77 years (mean 52.6 ± 16.7), with a history of reflex (group I) or cardiac syncope (group II). Diagnosis of syncope was performed according to the European Society of Cardiology (ESC) guidelines. In all patients, the concentration of NT-proBNP was measured. RESULTS: The assessment of NT-proBNP concentrations showed significantly higher concentrations in group II than in group I (448.7 ± 212.2 vs. 68.2 ± 64.1 pg/ml, P<0.0001). The receiver operating characteristic (ROC) curve analysis revealed that the concentration of NT-proBNP at 210.5 pg/ml may be a useful cut-off point which allows the prediction of cardiac syncope with 98 % specificity, 94 % sensitivity, and 94 % negative predictive value. In patients with cardiac arrhythmias and conduction abnormalities, the concentrations of NT-proBNP were higher in comparison to those without such disorders. CONCLUSIONS: The concentration of NT-proBNP is useful in the diagnosis of syncope and may initially guide the diagnostic process. The NT-proBNP value exceeding 200 pg/ml seems to be the most rational in determining cardiac syncope.

[Natriuretic peptides and their use in clinical practice according to the guidelines of the European Society of Cardiology]. / Peptydy natriuretyczne i ich zastosowanie w codziennej praktyce klinicznej wedlug wytycznych Europejskiego Towarzystwa Kardiologicznego.

In recent years, assay levels of natriuretic peptides are used in everyday clinical practice. The most commonly used is the assay the concentration of NT-proBNP in conjunction with the longest half-life (120 minutes) and its stability. According to the guidelines of the European Society of Cardiology determination of NT-proBNP were used in the diagnosis of acute and chronic heart failure, risk stratification in acute coronary syndromes, pulmonary embolism and in assessing the overall risk of cardiovascular patients prior to surgery. In addition, there are works whose authors have demonstrated the usefulness of NT-proBNP determination in valvular, atrial fibrillation, and syncope.

[Natriuretic peptides. History of discovery, chemical structure, mechanism of action and the removal routes. Basis of diagnostic and therapeutic use]. / Peptydy natriuretyczne. Historia odkrycia, budowa chemiczna, mechanizm dzialania oraz metabolizm. Podstawy zastosowania diagnostycznego i leczniczego.

Natriuretic peptides (NP) are the group of proteins synthesized and secreted by the mammalian heart. All the NP are synthesized from prohormones and have 17-amino acid cyclic structures containing two cysteine residues linked by internal disulphide bond. They are characterized by a wide range of actions, mainly through their membrane receptors. The NP regulate the water and electrolyte balance, blood pressure through their diuretic, natriuretic, and relaxating the vascular smooth muscles effects. They also affect the endocrine system and the nervous system. The neurohormonal regulation of blood circulation results are mainly based on antagonism with renin--angiotensin--aldosterone system. The NP representatives are: atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), C-type natriuretic peptide (CNP), urodilatine and (DNP) Dendroaspis natriuretic peptide, not found in the human body. According to the guidelines of the European Society of Cardiology determination of NT-proBNP level have found a use in the diagnosis of acute and chronic heart failure, risk stratification in acute coronary syndromes and pulmonary embolism. There are reports found in the literature, that demonstrate the usefulness of NT-proBNP determination in valvular, atrial fibrillation, and syncopes. Recombinant human ANP--Carperitid and BNP--Nesiritid, have already found a use in the adjunctive therapy of dyspnea in acute heart failure.

[Evaluation of plasma renin activity in acute myocardial infarction patients treated with primary percutaneous coronary interventions]. / Ocena aktywnosci reninowej osocza u osób z ostrym zawalem miesnia sercowego leczonych pierwotna angioplastyka wiencowa.

UNLABELLED: The aim of this study was evaluation of plasma renin activity (PRA) in patients with acute ST-segement elevation myocardial infarction (STEMI) treated with primary percutaneous coronary interventions (PCI). We observed 40 patients (30 men, 10 woman) aged 29-69 yrs (mean age 53.9 SD 10.9) with first ST-segment elevation myocardial infarction. Patients were treated with primary percutaneous coronary intervention (PCI) with implantation of bare metal stent in the period up to 6 hours after the onset of chest pain. Plasma renin activity was evaluated on 1st, 3rd and 5th day and 1st and 3rd month after STEMI in all patients. Values of PRA were compared between men and women during a 3-month follow-up. Echocardiography examinations with left ventricular parameter measurements (included ventricular ejection fraction) were performed at 3rd day, 1st and 3rd month after STEMI. In all patients Troponin I level was measured in the first day of STEMI. In addition, the level of NTproBNP and hsCRP in plasma were measured in all patients at 1st day, 1st and 3rd month after STEMI. Changes of PRA levels within 3-months follow-up were evaluated in relation to the age, BMI, serum levels of NTproBNP, hsCRP, lipids and left ventricular function. RESULTS: Median value of the PRA was 1.4 ng/ml/h at 1st day (N:1.46 +/- 0.23 ng/ml/h); 2.3 ng/ml/h at 3rd day; 3.9 ng/ml/h at 5th day; 2.1 ng/ml/h at 1 month, and 2.7 ng/ml/h at 3 months after STEMI. Peak value of PRA was observed between 5th day and 1st month after STEMI. PRA was significantly higher in men than in women at 1st day after STEMI (1.8 vs. 0.8 ng/ml/h; p = 0.002). There were no differences of PRA between men and women during the rest of the followup (3rd day - 3.3 vs. 2.0 ng/ml/h; 5th day 7.3 vs. 3.5 ng/ml/h; 1st month 4.1 vs. 2.1 ng/ml/h, 3rd month 3.5 vs. 2.2 ng/ml/h. There was no significant correlation between PRA and age, BMI, serum levels of NTproBNP, hsCRP, lipids and left ventricular function. CONCLUSIONS: 1. Values of PRA change within early period after STEMI. The peak value was achieved between 5th day and 1st month after STEMI treated with primary PCI. 2. Plasma renin activity was significantly higher in men than in women at 1st day of STEMI treated with primary PCI.

[Prevalence of age, gender and body weight on the frequency of hypertension and diabetes mellitus in patients hospitalized in cardiology department]. / Wplyw wieku, plci oraz masy ciala na czestosc wystépowania nadcisnienia tetniczego oraz cukrzycy, u pacjentów hospitalizowanych na oddziale kardiologicznym.

UNLABELLED: Overweight and obesity are a major medical problems of the twenty-first century. According to the World Health Organization (WHO) in the world are about 1.6 billion people with overweight and at least 400 million adults are obese. The aim of this study was to analyze the effects of age, sex, and selected anthropometric parameters on the incidence of hypertension and diabetes mellitus in patients hospitalized in the cardiology department. The study included 1188 patients aged 18 - 94 years (mean age 66.9 years, SD 13.2), including 610 men (mean age 65.9 years, SD 12.7) and 578 women (mean age 67.9 years, SD 13.7), hospitalized in the Department of Cardiology Specialist Hospital Louis Rydygier in Krakow in 2009. All patients defined age, height and weight. Based on these results calculated body mass index (BMI). All patients were collected history on the prevalence of hypertension and type 2 diabetes mellitus. Then performed a statistical analysis of the incidence of hypertension and diabetes mellitus compared to sex, median age, BMI. RESULTS: In the study population normal blood pressure and hypertension grade 2 occurred significantly more often in men. Grade 3 hypertension occurred significantly more often in women. The median age was 67 years. In the older group occurred more frequently hypertension 2 and Grade 3. Also, diabetes mellitus was more common among older people. In obese people (BMI> 30) and overweight (BMI 25-29.99) occurred significantly more grade 3 hypertension compared to those of normal weight. CONCLUSIONS: 1. Diabetes mellitus and hypertension are more common in postmenopausal women compared to men the same age. 2. Obesity and overweight predisposes to hypertension grade 3 and diabetes mellitus.

[Epidemiology of pulmonary embolism in patients with cardiac department]. / Epidemiologia zatorowosci plucnej u pacjentów oddzialu kardiologicznegom.

UNLABELLED: Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a embolic material. ZP is usually a manifestation of venous thromboembolism (VTE), which in addition to the ZP includes deep vein thrombosis. The aim of this study was to analyze the epidemiology of pulmonary embolism in patients in the cardiology department with regard to gender and age. Material for the study was the medical documentation of patients hospitalized in the Department of Cardiology Hospital Louis Rydygiera in Cracow in the period of 7 years (1 I 2004 - 31 December 2010). During this time 11,435 patients were hospitalized. The study included 67 (1.23%) patients (31 men, 36 women) aged 30 - 93 years (mean 70.3 years, SD 13.3) who were diagnosed with acute pulmonary embolism. Collected information on gender, age, body weight and coexisting disease. An analysis of the documentation in terms of symptoms on admission and the cause of pulmonary embolism. RESULTS: The study included 67 patients, aged 30 - 93 years (mean age 70.3 years, SD 13.3) including 31 males (mean age 71.7 years, SD 13.8) and 36 women (average age 69.1 years, SD 12.9). The incidence of pulmonary embolism was 6 people per 1000 hospital admissions (0.58%). The average age of women was lower compared to men (69.1 +/- 12.9 vs. 71.7 +/- 13.8 years). Among the most common coexisting diseases were coronary heart disease (44.8%), hyperlipidemia (40.3%) and varicose veins of the lower limbs (49.3%). The most common symptoms on admission were dyspnea (88.1%), chest pain (59.7%) and hypotension (44.8%). Among the predisposing factors for pulmonary embolism occurs most frequently in the history of surgery (55.2%), venous thrombosis of lower limbs (50.7%), smoking (34.3%). The median age was 70.3 years. Pulmonary embolism was significantly more common among older people (37.3% vs. 62.7%, p = 0.04) and in men (35.5% vs. 64.5%, p = 0.04) and women (38.9% vs. 61.1%, p = 0.04). Pulmonary embolism was reported most frequently in the age group between 70-79 years of age in the study group (43.3%). CONCLUSIONS: 1. Pulmonary embolism occurs in 6 per 1000 patients hospitalized in the cardiology department. 2. Pulmonary embolism occurs most frequently in the age group 70-79 years. 3. The most common factors that causes pulmonary embolism are state after surgery and a history of deep vein thrombosis.