Blood pressure variability: Epidemiological and clinical issues

Blood pressure variability (BPV) is a classical physiological phenomenon. This paper describesmajor epidemiological and clinical issues of BPV which may be important to understand thebackground of this interesting feature. In healthy subjects, BPV is a measure of hemodynamiccondition and refl ects function of autonomic nervous system. BP fl uctuations result from thecomplex interaction between environmental stimulation, genetic factors and cardiovascularcontrol mechanisms. Abnormal BPV is recognized in persons with a blurred dipping pattern(i.e. extreme dipping, non-dipping, reverse-dipping, morning surge of BP) or increased variationsof day-time or night-time BP (high BP lability). Inappropriate BPV worsens the outcome,including increase in all-cause and cardiac mortality and incidence of cardiovascular events,and advance in target organ damage. Abnormal BPV may be softened or removed with suitabletime-dependent administration of anti-hypertensive agents, especially those acting on therenin–angiotensin system

Left main disease management strategy: Indications and revascularization methods in particular groups of subjects

Surgical revascularization with coronary artery by-pass grafting is still recommended in vast majority of patients with unprotected left main disease. The aim of the paper was to analyze optimal treatment of left main disease in selected groups of patients, on the basis of current guidelines and information gained from literature data. We focused on data in relation to treatment of elderly patients, diabetics and those hemodynamically unstable. Additionally we discussed the issue of anti-platelet therapy and informed consent. As far as efficacy of treatment is concerned, not only method of revascularization but also general condition of the patient, the factors influencing peri-operative risk and optimal pharmacotherapy should be taken into account. Therefore establishment of the heart team is crucial when choosing the most suitable method of invasive treatment of left main disease

Prevalence of hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) in the population of adult asthmatics in Poland based on an epidemiological questionnaire

Introduction: Hypersensitivity reactions to drugs account for 25% of all side effects related to drugs, affecting more than 7% of the population. One in four such reactions is caused by acetylic acid and other non-steroidal anti-inflammatory drugs. Material and methods: Between 1998 and 2000 epidemiological research was carried out in various centers, with the aim of estimating the frequency of allergy-based diseases in Poland. The objective of the study was to evaluate the frequency of hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs), based on an epidemiological questionnaire, in the Polish adult population. Results: Bronchial asthma was diagnosed in 582 patients (5.4%). Of that group, 75 patients (12.9%) additionally reported symptoms of hypersensitivity to NSAIDs. Aspirin-induced asthma was diagnosed in 11 patients (14.7%) with clinical manifestations of hypersensitivity responses. Frequency of aspirin-induced asthma with clinical symptoms amounted to 1.9% of asthmatics. In the assessment of severity of the disease, aspirin intolerance was the only statistically significant factor (p = 0.0003; odds ratio 28.6 with assumed 95% confidence interval). Conclusions: In the population of adults in Poland, the frequency of aspirin-induced asthma amounted to 0.1%. Hypersensitivity to NSAIDs was observed in 12.9% of asthmatics. In asthmatics with symptoms of hypersensitivity to non-steroidal anti-inflammatory drugs, which takes the course of clinically demonstrable aspirin-induced asthma, the risk of severe asthma is 30-fold higher

Prevalence of hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) in the population of adult asthmatics in Poland based on an epidemiological questionnaire

Wstęp: Reakcje nadwrażliwości na leki stanowią około 25% działań niepożądanych leków i dotyczą ponad 7% ogólnej populacji. Kwas acetylosalicylowy i inne niesteroidowe leki przeciwzapalne (NLPZ) w jednej czwartej przypadków odpowiadają za te reakcje. Materiał i metody: W latach 1998–2000 przeprowadzono wieloośrodkowe badanie epidemiologiczne, mające oszacować częstość występowania schorzeń alergicznych w Polsce. Celem autorów pracy była próba oceny częstości występowania reakcji nadwrażliwości na NLPZ w populacji dorosłych cierpiących na astmę w Polsce, na podstawie prowadzonych badań epidemiologicznych. Wyniki: Badanie objęło grupę 10 684 dorosłych osób w Polsce. Astmę oskrzelową rozpoznano u 582 (5,4%) badanej populacji. W grupie tej 75 chorych (12,9%) zgłaszało objawy nadwrażliwości na NLPZ. Częstość występowania astmy aspirynowej wyniosła 1,9% wśród wszystkich chorych na astmę. W grupie z nadwrażliwością na NLPZ astmę przewlekłą umiarkowaną choi ciężką rozpoznano u 21,3% chorych. W ocenie ciężkości astmy wśród populacji badanej istotność statystyczną uzyskano w tylko w przypadku nietolerancji na aspirynę (p = 0,0003; iloraz szans 28,6 przy założonym 95-procentowym przedziale ufności). Wnioski: Częstość występowania astmy aspirynowej w populacji osób dorosłych w Polsce wynosi 0,1%, natomiast wśród dorosłych chorych na astmę oskrzelową stanowi 1,9%. Reakcje nadwrażliwości na NLPZ występują u 12,9% dorosłych chorych na astmę w Polsce. Chorych na astmę aspirynową charakteryzuje statystycznie znamiennie cięższy przebieg choroby w porównaniu do chorych na astmę tolerujących aspirynę. Ryzyko wystąpienia u nich ciężkiego przebiegu astmy jest zwiększone blisko 30-krotnie.Introduction: Hypersensitivity reactions to drugs account for 25% of all side effects related to drugs, affecting more than 7% of the population. One in four such reactions is caused by acetylic acid and other non-steroidal anti-inflammatory drugs. Material and methods: Between 1998 and 2000 epidemiological research was carried out in various centers, with the aim of estimating the frequency of allergy-based diseases in Poland. The objective of the study was to evaluate the frequency of hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs), based on an epidemiological questionnaire, in the Polish adult population. Results: Bronchial asthma was diagnosed in 582 patients (5.4%). Of that group, 75 patients (12.9%) additionally reported symptoms of hypersensitivity to NSAIDs. Aspirin-induced asthma was diagnosed in 11 patients (14.7%) with clinical manifestations of hypersensitivity responses. Frequency of aspirin-induced asthma with clinical symptoms amounted to 1.9% of asthmatics. In the assessment of severity of the disease, aspirin intolerance was the only statistically significant factor (p = 0.0003; odds ratio 28.6 with assumed 95% confidence interval). Conclusions: In the population of adults in Poland, the frequency of aspirin-induced asthma amounted to 0.1%. Hypersensitivity to NSAIDs was observed in 12.9% of asthmatics. In asthmatics with symptoms of hypersensitivity to non-steroidal anti-inflammatory drugs, which takes the course of clinically demonstrable aspirin-induced asthma, the risk of severe asthma is 30-fold higher

Certain subphenotypes of aspirin-exacerbated respiratory disease distinguished by latent class analysis

Background: Aspirin-exacerbated respiratory disease (AERD) is recognized as a distinct asthma phenotype. It usually has a severe course accompanied by chronic hyperplastic eosinophilic sinusitis with nasal polyps, blood eosinophilia, and increased concentrations of urinary leukotriene E4 (LTE4). More insightful analysis of individual patients shows this group to be nonhomogeneous. Objective: We sought to identify any likely subphenotypes in a cohort of patients with AERD through the application of latent class analysis (LCA). Methods: Clinical data from 201 patients with AERD (134 women) were collected from questionnaires. Standard spirometry, atopy traits, blood eosinophilia, and urinary LTE4 concentrations were evaluated. LCA was applied to identify possible AERD subphenotypes. Results: Four classes (subphenotypes) within the AERD phenotype were identified as follows: class 1, asthma with a moderate course, intensive upper airway symptoms, and blood eosinophilia (18.9% of patients); class 2, asthma with a mild course, relatively well controlled, and with low health care use (34.8% of patients); class 3, asthma with a severe course, poorly controlled, and with severe exacerbations and airway obstruction (41.3% of patients); and class 4, poorly controlled asthma with frequent and severe exacerbations in female subjects (5.0% of patients). Atopic status did not affect class membership. Patients with particularly intensive upper airway symptoms had the highest levels of blood eosinophilia and the highest concentrations of urinary LTE4. Conclusions: LCA revealed unique AERD subphenotypes, thus corroborating the heterogeneity of this population. Such discrimination might facilitate more individualized treatment in difficult-to-treat patients

Over-the-counter medicines and dietary supplements consumption among academic youth in Poland

Over-the-counter (OTC) medicines and dietary supplements are increasingly popular in Poland, potentially improving overall health but also posing a threat to public health. The study goal is to characterize and assess behaviors related to use of OTC medicines and dietary supplements among Polish university students. A questionnaire-based survey was performed with students divided into groups (gender, subjects studied, period of studies). The majority of students declared using the products, significantly more females and younger students in their early years. Females tended to be more attentive to product information. Students with a background in biological or medical sciences were also more attentive and less influenced by advertising. We conclude that the differences between the defined groups of students should be utilized in tailored educational activities, aiming to rationalize high consumption of OTC medicines and dietary supplements. Targeting other, especially poor and less-educated groups, should follow