Application of novel dual wave meal bolus and its impact on glycated hemoglobin A1c level in children with type 1 diabetes.

BACKGROUND: An insulin pump is an advanced technology offering new options of bolus - normal (N), dual wave (D-W) or square wave (S-W) bolus to deliver mealtime insulin. OBJECTIVES: To assess the impact of D-W/S-W boluses on metabolic control (glycated haemoglobin A1c, HbA1c) and to estimate the paediatric patients compliance with implementation of this system in daily practice. METHODS: The cross-sectional study included 499 records of patients aged 0-18 yr. Data from the insulin pump memory provided information on the number of D-W/S-W boluses during a 2-wk period, the insulin requirement (U/kg/d) and the percentage of basal insulin. The HbA1c value (%) and the patient's weight were determined during medical examinations. Mealtime dose of insulin in D-W/S-W bolus was calculated based on the amount of carbohydrate and fat/protein products. RESULTS: The number of applied D-W/S-W boluses was 16.6 +/- 0.77/14 d (ranged 0-95), while 18.8% of patients did not program D-W/S-W boluses. The lowest HbA1c value was found in the group using two and/or more D-W/S-W boluses per day (p = 0.001) compared with the group administrating less than one D-W/S-W bolus/d. Patients with HbA1c level <7.5% had a statistically higher relevant number of D-W/S-W boluses, 19.55 (95% CI: 17.44-21.65) vs. 12.42 (95% CI: 10.22-14.61) (p < 0.001), while there was no correlation between the number of boluses and HbA1c in patients in the remission phase (<0.5 IU/kg/d) (r = 0.012, p = 0.930). CONCLUSIONS: Patients using at least one D-W/S-W bolus per day achieved a recommended level of HbA1c. Paediatric patients with type 1 diabetes mellitus were found to be able to apply D-W/S-W boluses in daily self-treatment process based on food counting.

The influence of dinoprostone on uterine cervix ripening and the course of labor.

OBJECTIVES: The aim of the study was to estimate the influence of dinoprostone in two different forms on the ripening of uterine cervix and the course of labor. MATERIAL AND METHODS: 128 pregnant women with indications for labor induction and uterine cervix Bishop's scores <6, divided into 2 groups: I--62 patients who had dinoprostone in the form of a gel applied for labor preinduction; II--66 women who were administered dinoprostone in the form of vaginal inserts. The effectiveness of both forms of dinoprostone were estimated and compared. RESULTS: No differences in Bishop's score changes were noticeable between the groups after 6-8 hours from application, however they were significant at the beginning of induction: I - 7.8+/-1.3 vs. II - 6.9+/-1.6 (p=0.0007). Almost half of the patients from group II had spontaneous contractions and required no labor induction at all. The average time from dinoprostone application till delivery was shorter in group II. CONCLUSIONS: Dinoprostone vaginal inserts seem to influence both uterine cervix and muscle, while gel-prepare uterine cervix for delivery more effectively.

Relation between impaired antiplatelet response to clopidogrel and possible pleiotropic effects.

BACKGROUND: The study was designed to determine whether impaired antiplatelet response to clopidogrel but not to aspirin may be responsible for loss of pleiotropic effects of the drug. METHODS: Study included 34 consecutive patients with STEMI undergoing primary percutaneous coronary intervention (PCI) with stent implantation treated with aspirin (loading dose 300 mg followed by 75 mg/day) and clopidogrel (loading dose 600 mg followed by 75 mg/day). On the basis of Platelet Function Analyzer (PFA)-100 test which measured closure times (CT) in test with collagen/epinephrine (CEPI-CT) or collagen/adenosine diphosphate (CADP-CT) patients were stratified after 7 days from admission as full aspirin or clopidogrel responders (CEPI-CT or CADP-CT = 300 sec., respectively) and non-full aspirin or clopidogrel responders (CEPI-CT or CADP-CT < 300 sec., respectively). High sensitivity C-reactive protein (hs-CRP) was measured at baseline and after 7 days of treatment. RESULTS: All patients received comparable statin treatment. Median and interquartile ranges (IQR) of hs-CRP increased significantly from 2.5 mg/L (0.4-44.8) at baseline to 8.05 mg/L (1.4-33.9) at day 7 (P = .002) in non-full clopidogrel responders subgroup and only slightly in the full clopidogrel responders subgroup (2.45 mg/L, IQR 0.4-48.3 vs. 4.2 mg/L, IQR 1.9-17.5) (P = .3) remaining within reference intervals. On the contrary median and IQR of hs-CRP increased significantly in both non-full aspirin responders (2.4 mg/L, IQR 1.3-3.3 vs. 5.8 mg/L, IQR 3.2-14.8, P = .01) and full aspirin responders (2.9 mg/L, IQR 2.0-3.7 vs. 5.6 mg/L, IQR 4.3-12.9, P = .04). CONCLUSIONS: Impaired antiplatelet response to clopidogrel but not to aspirin may contribute to smaller anti-inflammatory response in patients with ST-elevation myocardial infarction.

Persistent platelet activation is related to very early cardiovascular events in patients with acute coronary syndromes.

INTRODUCTION: Persistent platelet function while on antiplatelet therapy affects outcomes in patients with acute coronary syndromes (ACS). AIM: To evaluate whether platelet reactivity measured by collagen-epinephrine (CEPI) or collagen-ADP (CADP) closure times (CT) with Platelet Function Analyzer 100 (PFA-100) is related to very early, in-hospital cardiovascular events in patients with ACS. METHODS: The study included 91 patients with ACS undergoing percutaneous coronary intervention (PCI) with stent implantation who were treated with aspirin and clopidogrel. Patients were stratified in accordance with both CEPI-CT (<190 s or >190 s), reflecting aspirin resistance, and our own cut-off point for CADP-CT measured at a mean of 6 days after admission. In-hospital events included re-infarction, cardiac arrest, recurrent angina, severe arrythmias, pulmonary oedema and cardiogenic shock. RESULTS: Patients were divided into 4 study groups: group 1 with CADP-CT <104 s (n=10, 11.0%), group 2 with CEPI-CT <190 s (n=10, 11.0%), group 3 with CADP-CT <104 s and CEPI-CT <190 s (n=9, 9.9%) and a control group with both CT values above the cut-off limits (n=62, 68.1%). The baseline clinical characteristics and received treatment of each subgroup were similar. A test for a trend between controls, group 1 or 2 and group 3 disclosed statistical significance (p <0.001). When analysed separately, only patients from group 3 had a higher incidence of negative outcomes compared to controls (p <0.005; relative risk RR - 9.0; 95% CI 2.4-33.9). CONCLUSIONS: Enhanced platelet function after PCI when measured under high shear rates by both PFA-100 cartridges is independently associated with the most unfavourable in-hospital clinical outcome.

[The influence of influenza vaccination on asthma and chronic obstructive pulmonary disease]. / Wplyw szczepien przeciwko grypie na przebieg astmy i przewleklej obturacyjnej choroby pluc.

UNLABELLED: Respiratory infections are the most common causes of exacerbations of asthma and chronic obstructive pulmonary disease (COPD). The influenza vaccinations are recommended in prophylaxis of respiratory infections. The aim of our study was to evaluate the influence of influenza vaccinations on asthma or COPD. 178 patients (55.1% with asthma, 44.9% with COPD) of Out-patient Clinic of Department of Internal Diseases, Pulmonology and Allergology of Warsaw Medical University filled the questionnaires. In 2003/2004 season 43.3% (77) of all were vaccinated against influenza. The frequency of vaccinations was significantly higher in patients >65 years of age 58.4% (45) than in younger ones [41.6% (32)]. The number of exacerbations decreased more than twice comparing the time before and after immunization: 1.7+/-1.5 and 3.9+/-2.4 per year respectively (p<0.00001). CONCLUSIONS: The influenza vaccinations is a useful method of decreasing the number of exacerbations in patients with asthma and COPD. The elder patients are vacacinated more often than younger ones. The frequency of vaccinations among patients with asthma and COPD is still not satisfactory.