Causes of deaths in COPD patients in primary care setting--a 6-year follow-up.

INTRODUCTION: COPD is one of the most frequent respiratory diseases responsible for patients' disability and mortality. In 2005 a single primary care practice, COPD was diagnosed in 183 out of 1,960 eligible subjects ≥ 40 years (9.3%). The aim of this study was to assess mortality rate and causes of deaths in this group after 6 years. MATERIAL AND METHODS: In 2011 we invited all 183 patients with COPD recognised in 2005. We performed spirometry, physical examination, questionnaire of respiratory symptoms, smoking habits, concomitant diseases and treatment. Information about deaths was taken from primary care register, furthermore, family members were asked to deliver medical documentation or death certificate. RESULTS: In 2011 we studied only 74 subjects (40.4%), 43 subjects died (23.5%) and 66 subjects were lost from the follow-up (36.1%). Cardiovascular diseases were the most frequent causes of deaths - 21 subjects (48.8%) (heart attack - 8 patients and stroke - 8 patients). Respiratory failure in the course of COPD exacerbation was the cause of 10 deaths (23.3%). Neoplastic diseases lead to 9 deaths (20.9%) (lung cancer 7 patients). Renal insufficiency was responsible for one death (2.325%), and the causes of 2 deaths remained unknown (4.65%). Subjects who died (predominantly males) were older, had higher MRC score and lower FEV1. CONCLUSIONS: Study performed six years after COPD diagnosis revealed that 23.5% of subjects died. The main causes of deaths were the following: cardiovascular diseases (mainly heart attack and stroke), COPD exacerbations and lung cancer (more than 75%). Death risk in COPD patients was associated with age, male sex, dyspnoea and severity of the disease.

[Prevalence of latent infection with Mycobacterium tuberculosis in Mazovia Region using interferon gamma release assay after stimulation with specific antigens ESAT-6 and CFP-10]. / Ocena czestosci wystepowania zakazenia pratkiem gruzlicyw populacji województwa mazowieckiego na podstawie wynikutestu mierzacego uwalnianie interferonu gamma po stymulacjiswoistymi antygenami ESAT-6 i CFP-10.

INTRODUCTION: Over 8000 cases of tuberculosis (TB) are diagnosed annually in Poland. People infected with Mycobacterium tuberculosis (MTB) have a risk of active disease around 10% during whole life, the risk is biggest in the first two years after infection. Recognizing infection before TB disease occurred enables prophylaxis against its activation and ceases transmission of infection. Knowledge about proportion of infected people in the population is crucial to predict the number of new cases of active disease. MATERIAL AND METHODS: Prevalence of latent TB infection (LTBI) was tested in 700 healthy adult inhabitants of Mazovia Region in different age groups, using both tuberculin skin test (TST) and interferon gamma release assay (IGRA). Commercial test QuantiFERON(®)-TB-Gold In Tube (QFT) was used. All participants were mandatory BCG vaccinated according to Polish vaccination schedule. RESULTS: Twenty three per cent of participants tested positively for QFT, which was significantly less than positive results of TST (50.3%). Prevalence of positive QFT result increased with age, as does the incidence of TB in Poland. Positive QFT was most frequent in the oldest age group (48.8%) and rare in the youngest (7.1%). On the contrary, positive TST occurred more often in younger participants (45%), who rarely suffer from TB. Among people over 60, who have the highest TB incidence rate, only 33.8% tested positively with TST. Concordance between both tests was low, with kappa value 0.198. Prevalence of LTBI defined as positive QFT among health care workers (HCW) was significantly higher than in other participants (32.2% v. 20.4%, p 〈 0.01). CONCLUSIONS: LTBI was diagnosed in 23.3% of tested population of Mazovia Region. QFT is a better tool for diagnosing LTBI as it shows positive correlation with age, the same as incidence of TB disease does. Concordance between both tests is low. Prevalence of LTBI in HCW is higher than in other participants.

Clinical and morphological aspects of thin glomerular basement membrane disease.

The report presents the results of investigations carried out in 63 patients (49 children and 14 adults) with thin glomerular basement membrane disease. Of 49 children, 13 came from nine families with family members suffering from kidney diseases (mostly manifested by haematuria). In the group of children, the most frequent initial clinical symptom (noted in 29 cases) was isolated haematuria, more rarely (in eight cases) haematuria and proteinuria, and (in seven cases) nephrotic syndrome. Isolated proteinuria was observed in another three children. In the adults, only in five patients was isolated haematuria the initial symptom of the disease; more frequently (in seven cases), they presented with isolated proteinuria. In two patients, proteinuria and haematuria were noted. In the two groups of patients, in addition to markers of thin glomerular basement membrane disease, the authors also observed markers indicative of other glomerulopathies: in seven children and four adults focal segmental glomerulosclerosis (FSGS) without any other glomerular pathologies (with the exception of thin glomerular basement membrane disease). Also in cases in which in addition to thin glomerular basement membrane disease other glomerular pathologies were present (mesangial hypercellularity, mesangial glomerulonephritis), matrix expansion was detected; this phenomenon might be considered a harbinger of glomerular sclerosis. In general, although not in each and every case, these pathologies were associated with duration of the disease.

[Smoking habits in a family physician's practice]. / Palenie tytoniu wsród podopiecznych lekarza rodzinnego.

INTRODUCTION: Poland is the one of the countries in the European Union with the highest prevalence of smokers. The involvement of family physicians in smoking cessation activity could improve this situation. The aim of this study was to estimate smoking habits, their intensity and nicotine dependence in a family physician's practice (urban and rural population). An additional aim was to estimate smoking habits in relation to the presence of smoking-related disease, gender, location and motivation to stop smoking. MATERIAL AND METHODS: This study was part of an investigation into the prevalence and severity of chronic obstructive pulmonary disease (COPD) in the same population. Statistical analysis of questionnaires about smoking and history of respiratory diseases, Fagerström's nicotine dependence test and a motivation to quit test were performed. RESULTS: Questionnaires were filled in by 1960 subjects (87% of those eligible). There were 29.6% current smokers, 24.9% ex-smokers, and 45.5% never-smokers. There were 39.4% current smokers among men, and 23.3% among women. Current smokers were more numerous in the rural population. 54% of women urban dwellers and 73% of women from rural population never smoked. There were no significant differences in the motivation to stop smoking or in the nicotine dependence among smokers with and without COPD nor according to the severity of COPD. CONCLUSIONS: Smoking habits among the studied population were comparable with national and regional data. The intensity of smoking habits among female town dwellers is especially alarming.

The prognostic value of glomerular immaturity in the nephrotic syndrome in children.

The study group consisted of 16 children (9 boys and 7 girls) aged 6-52 months (mean age 27 months) with a first episode of nephrotic syndrome. Histological diagnosis (diffuse mesangial proliferation with signs of glomerular immaturity) was established by renal biopsy. The control group consisted of 47 children (26 boys and 21 girls) aged 7-58 months (mean 29 months) hospitalized with a first episode of nephrotic syndrome with diffuse mesangial proliferation, documented exclusively by histological examination. The aim of the study was to analyze the clinical course of a first episode of nephrotic syndrome in children with diffuse mesangial proliferation with and without signs of glomerular immaturity. In children with a first episode of the nephrotic syndrome and glomerular immaturity steroid resistance was more frequent (P=0.0234). Furthermore, in the study group there was a less favorable clinical course of the disease in children younger than 1 year of age and with an original serum albumin concentration lower than 1.0 g/dl. Hence, the presence of relatively rare signs of glomerular immaturity influences unfavorably the course and treatment of nephrotic syndrome in children.

[Influence of autonomic nervous system on electrolyte abnormalities in children with mitral valve prolapse]. / Wplyw autonomicznego ukladu nerwowego na wystepowanie zaburzen elektrolitowych u dzieci z wypadaniem platków zastawki dwudzielnej.

Measurement of the heart rate variability enables to assess the activity of the autonomous nervous system. The aim of the study was to evaluate the possible relationship between clinical status, serum sodium (Na), potassium (K), calcium (Ca), magnesium concentrations and HRV in children with mitral valve prolapse. The study group consisted of 151 children with MVP (age +/- SD: 12.2 +/- 3.1 years). Thirty patients out of the MVP group were symptomatic and 121 were asymptomatic. The total number of 165 healthy children (age +/- SD: 12.3 +/- 3.7 years) were included into the control group. We assessed power spectrum of HRV (low frequency component--LF, high frequency component--HF, and LF/HF ratio) from 5-minute recording during daytime and night. Serum Mg (p < 0.00001) and K (p < 0.03) concentrations were significantly lower in MVP group as compared to healthy children. A marked decrease in Mg concentration was observed in symptomatic children with MVP as compared to asymptomatic patients (p < 0.0001). A significant positive correlation was found between Mg concentration and HF and HF n.u. components (daytime and night) and significant negative correlation was observed between Mg concentration and LF and LF n.u. (daytime and night) parameters and LF/HF ratio (daytime and night). Symptomatic children with MVP had significantly higher LF n.u. and LF/HF ratio and a lower HF n.u. as compared to asymptomatic patients. The autonomic changes in MVP children (reduction in parasympathetic tone with sympathetic predominance) were associated with decreased serum Mg concentration and higher prevalence of clinical symptoms. Mg supplementation seems to be a prudent approach in symptomatic children with MVP.

[Intracellular synthesis of cytokines as the index of function of peripheral blood lymphocytes and monocytes in children with first relapse of nephrotic syndrome]. / Wewnatrzkomórkowa synteza cytokin jako wykladnik funkcji limfocytów i monocytów u dzieci z I rzutem zespolu nerczycowego.

BACKGROUND: Nephrotic Syndrome (NS) is a disease in which immune system function disorders play an important role. The aim of the study was an assessment of intracellular expression of cytokines in primary NS including assessment of intracellular expression of monokines (TNF-alpha, IL-8) in non-specific LPS stimulation system and intracellular expression of lymphokines (IL-2, INF-gamma, IL-4, IL-6) in experimental system with application of stimulation with ionomycin and PMA. METHODS: The study included 47 children with NS aged 2-16 years. After activation of whole blood cells in the presence of brefeldin A the cells were labelled with monoclonal antibodies against surface antigens. In the second phase the cells underwent permeabilisation and were labelled with monoclonal antibodies against individual cytokines. RESULTS: The studies performed demonstrated in children with NS relapse an increase of intracellular synthesis of cytokines characteristic of Th1 system (IL-2) and a decrease of synthesis of cytokines characteristic of Th2 system (IL-4, IL-6). In these patients an increase was also found of intracellular synthesis of proinflammatory monokines (TNF-alpha and IL-8). The studies performed, confirmed the earlier observations concerning abnormal cellular response in NS and demonstrated that differences in serum concentrations of individual cytokines may result from disturbances in their intracellular synthesis.

Decreased antioxidant activity in hypercholesterolemic children with nephrotic syndrome.

BACKGROUND: The aim of the present study was to estimate the total antioxidant status (TAS) and main antioxidant enzyme activity in children with nephrotic syndrome (NS). MATERIAL/METHODS: The study was carried out in a group of 82 children with NS, age 4-16 years (mean 7.4). Of these, 59 with a first episode formed group I, and 23 children in remission (>6 months, with no immunosuppressive treatment) formed group II. TAS was estimated using the two-reagent Randox Total Antioxidant Status test in plasma. RESULTS: TAS was significantly reduced in group I compared to controls (0.77+/-0.14 mmol/l vs. 1.18+/-0.42 mmol/l; p<0.001). The TAS level was more reduced in those patients with higher total cholesterol (TChol) and low density lipoproteins cholesterol (LDL-cholesterol). In children from group I the activity of glutathione reductase (GR) was lower than in the controls (8.10+/-2.40 U/g Hb vs. 10.55+/-3.81 U/g Hb, p<0.001) and similarly the activity of glutathione peroxidase (GPX) was lower in group I compared to controls (28.65+/-6.99 U/g Hb vs. 33.84+/-13.11 U/g Hb, p=0.010). There was no significant difference in superoxide dismutase (SOD) activity between the 3 groups. CONCLUSIONS: Reduced antioxidant activity may be related to lipid abnormalities in NS.

A prospective study to determine the significance of ventricular late potentials in children with mitral valvar prolapse.

We aimed prospectively to determine the incidence of ventricular arrhythmias and ventricular late potentials in children with mitral valvar prolapse, and to assess whether signal-averaged electrocardiography could identify which such children were at high risk of developing ventricular tachycardia. In all, we examined 151 children with mitral valvar prolapse, at an age of 12.2 +/- 3.1 years, and 164 healthy subjects aged 12.3 +/- 3.7 years. All children underwent 24-hour ambulatory Holter monitoring and echocardiography. The children with mitral valvar prolapse were followed prospectively for a mean of 64 months. There was a significantly higher prevalence of ventricular arrhythmias in those with prolapse than in the controls (p < 0.0001). Runs of ventricular tachycardia were observed in 3 children with mitral valvar prolapse compared with one from the control group. Late potentials were more frequently observed in the children with mitral valvar prolapse than in those who were healthy (p < 0.0001), and also in those with prolapse suffering ventricular arrhythmias compared with those without ventricular arrhythmias (p < 0.02). During follow-up, 24 children with prolapsing mitral valves developed non-sustained ventricular tachycardia, giving a frequency of 3.1/100 subject-years. The sensitivity of late potentials was low, at 52%, for the identification of children with mitral valvar prolapse who developed ventricular tachycardia, although the specificity was high at 90%. This gave a positive predictive value of 50%, and a negative predictive value of 91%. We conclude that prolapse of the mitral valve predisposes to the development of ventricular arrhythmias and late potentials in children. An abnormal signal-averaged electrocardiogram is a specific, but not very sensitive, predictor for the development of ventricular tachycardia in such children.

[Clinical investigations of children with chronic renal failure and peritonitis treated with peritoneal dialysis]. / Obserwacje kliniczne dzieci i mlodziezy z zapaleniem otrzewnej w przebiegu leczenia przewleklej niewydolnosci nerek ciagla dializa otrzewnowa.

UNLABELLED: Peritonitis and catheter-related infection are the most-common complications of peritoneal dialysis treatment. The aim of study was to analyse frequency causes, effectiveness of therapy and risk factors of peritonitis in patients treated with continuous peritoneal dialysis (CAPD). We described 13 patients aged 6-21 years, mean 12 years, who initiated CAPD between 1995 to 2000. The most-common primary cause of end-stage renal disease were chronic glomerulonephritis in 8 children, renal dysplasia in 3 children, hemolytic-uremic syndrome in 1 child and obstruction uropathy in 1 child. Peritonitis rate was 1 episode for 9 patient months. Staphylococcus aureus was the most-common infection factor. We performed exchange of catheter in 8 children. Causes of exchange were exit site infection, cuff excision, tunnel infection and peritonitis. Children were usually treated with two antibiotics for two weeks. Effect of treatment was better in these episodes treated longer than two weeks. As a risk factors of increasing peritonitis relapses we suggest immunosuppressive therapy, protein deficiency, catheter dislocation, not adequate education of patient family and chronic skin infections. We observed lower rate of peritonitis relapses in patients treated longer than two years on CAPD. CONCLUSIONS: 1. In patients with chronic renal failure treated with CAPD the preceding immunosupressive therapy increases the frequency of peritonitis. 2. More intensive treatment can cause decreasing frequency of peritonitis relapses. 3. Some risk factors increase the frequency of peritonitis relapses. 4. A better education of patient and his family decreases the frequency of peritonitis relapses.

Increased apoptosis of peripheral blood lymphocytes in children with nephrotic syndrome.

Nephrotic syndrome is accompanied by and probably related to abnormal T-lymphocyte function. Decreased stimulation of survival factors and increased levels of "dead signals" may lead to the malfunction of many cells, including lymphocytes. In our study, we investigated the process of apoptosis within T cells in children with a first attack of nephrotic syndrome (NS). We found that the number of apoptotic T cells is greater in these patients than in both children in remission from NS and in controls. The percentage of annexin-V-fluorescein isothiocyanate (FITC)-positive CD3+ cells was 27.30+/- 12.13% in children with a first attack of NS, 19.22+/- 15.16% (P=0.006) in children in remission and 16.20+/- 6.13% (P=0.004) in controls. The percentage of annexin-V-FITC-positive CD3+CD4+ cells was 7.35+/-7.72% in children with a first attack of NS, 3.80+/-3.75% (P=0.0001) in children in remission and 3.82+/-2.01% (P=0.0002) in controls. We conclude that abnormal number and function of T lymphocytes found in NS patients may be related to an increased apoptotic rate of circulating lymphocytes.

Echocardiographic parameters of left ventricular systolic and diastolic function in infants, children and adolescents before and after surgical correction of secundum atrial septal defect.

BACKGROUND: Left ventricular (LV) dysfunction has been described in adults with secundum atrial septal defect (ASD II) and heart failure (CHF). This anomaly has been rarely regarded as a cause of CHF in pediatric patients with ASD II. AIM: To assess LV systolic and diastolic function in patients with ASD II before and after cardiosurgery as well as to establish the prognostic value of these parameters in infants, children and adolescents with ASD II. METHODS: LV systolic (LVEF) and diastolic function parameters (E/A, DCT, IVRT) were studied using Doppler echocardiography in 104 patients aged between 1-18 years with ASD II before cardiosurgery and 4 years afterwards. These parameters were compared with similar variables in 150 healthy infants, children and adolescents. RESULTS: Before surgery LVEF was significantly lower only in infants with ASD II and CHF when compared with healthy controls. Relaxation abnormalities of LV diastolic function were observed before surgery in 40.4% of patients, especially in infants and adolescents with CHF. These disturbances were still present in about 20% of patients after surgery, especially in infants. Before and after surgery both LV and RV end-diastolic volumes were normal in about 6-10% of patients with LV diastolic dysfunction. CONCLUSIONS: In patients with ASD II and CHF diastolic dysfunction of LV is more common than systolic dysfunction. RV volume overload mainly affects LV diastolic function but it is not the only cause of CHF in patients with ASD II, especially in infants and adolescents. After surgery, normalisation of LV diastolic function is not observed in about 20% of patients with ASD II, especially in those who had CHF before operation. Special monitoring of the circulatory system is necessary in patients with ASD II operated in infancy and adolescence.