Plasminogen activator inhibitor-1 (PAI-1) and urokinase plasminogen activator (uPA) in sputum of allergic asthma patients.

Urokinase plasminogen activator (uPA) and its inhibitor (PAI-1) have been associated with asthma. The aim of this study was to evaluate concentration of uPA and PAI-1 in induced sputum of house dust mite allergic asthmatics (HDM-AAs). The study was performed on 19 HDM-AAs and 8 healthy nonatopic controls (HCs). Concentration of uPA and PAI-1 was evaluated in induced sputum supernatants using ELISA method. In HDM-AAs the median sputum concentration of uPA (128 pg/ml; 95% CI 99 to 183 pg/ml) and PAI-1 (4063 pg/ml; 95%CI 3319 to 4784 pg/ml) were significantly greater than in HCs (17 pg/ml; 95%CI 12 to 32 pg/ml;

The statement of the Polish Society of Allergology experts on the treatment of difficult-to-treat asthma

The main objective of asthma treatment is to control symptoms of the disease; however, despite the availability of guidelines and many groups of medications, the degree of control of this condition is insufficient. In difficult-to-treat asthma, the optimal control cannot be achieved due to reasons independent of the disease. Factors worsening asthma control include: inadequate treatment plan (low therapy adherence and compliance), inappropriate inhalation technique, insufficient symptom control using the available classes of medications, incomplete response to treatment (non-responders, steroid-resistance), incorrect diagnosis of asthma or comorbidities, and environmental factors. In order to achieve the optimal asthma control, it is recommended to: take therapeutic decisions with the patient, assess the probability of non-compliance, perform detailed diagnostics and initiate treatment of concomitant diseases, carry out differential diagnosis of conditions mimicking asthma, educate the patient as to the inhalation technique and check it, eliminate unfavourable environmental factors, and modify current treatment. New treatment options for patients with asthma include: ultra-long-acting beta2-agonists, long-acting muscarine receptor antagonists (LAMA), monoclonal antibodies, and non-pharmacological interventions. The only LAMA approved for treatment of asthma is tiotropium bromide. The analyses performed demonstrated a high efficacy of tiotropium in terms of improved lung function parameters and prolonged time to the first asthma exacerbation. It is recommended as an add-on therapy at asthma treatment steps 4 and 5 according to GINA (Global Initiative for Asthma) 2014. The optimal asthma control is important from the medical as well as the economical point of view.The main objective of asthma treatment is to control symptoms of the disease; however, despite the availability of guidelines and many groups of medications, the degree of control of this condition is insufficient. In difficult-to-treat asthma, the optimal control cannot be achieved due to reasons independent of the disease. Factors worsening asthma control include: inadequate treatment plan (low therapy adherence and compliance), inappropriate inhalation technique, insufficient symptom control using the available classes of medications, incomplete response to treatment (non-responders, steroid-resistance), incorrect diagnosis of asthma or comorbidities, and environmental factors. In order to achieve the optimal asthma control, it is recommended to: take therapeutic decisions with the patient, assess the probability of non-compliance, perform detailed diagnostics and initiate treatment of concomitant diseases, carry out differential diagnosis of conditions mimicking asthma, educate the patient as to the inhalation technique and check it, eliminate unfavourable environmental factors, and modify current treatment. New treatment options for patients with asthma include: ultra-long-acting beta2-agonists, long-acting muscarine receptor antagonists (LAMA), monoclonal antibodies, and non-pharmacological interventions. The only LAMA approved for treatment of asthma is tiotropium bromide. The analyses performed demonstrated a high efficacy of tiotropium in terms of improved lung function parameters and prolonged time to the first asthma exacerbation. It is recommended as an add-on therapy at asthma treatment steps 4 and 5 according to GINA (Global Initiative for Asthma) 2014. The optimal asthma control is important from the medical as well as the economical point of view

Czy oznaczanie stężeń peptydów natriuretycznych BNP i NT-proBNP przynosi korzyści w postępowaniu z pacjentem z nagłą dusznością?

W badaniach z ostatnich lat wykazano, że ocena peptydów natriuretycznych przeprowadzona u pacjentów z dusznością pozwala znacznie zwiększyć dokładność, z jaką może być wykluczone lub potwierdzone rozpoznanie niewydolności serca. Tym niemniej do dziś nie udało się jednoznacznie ustalić, czy wprowadzenie do rutynowej diagnostyki oznaczeń peptydów natriuretycznych u tych pacjentów mogłoby przynieść wymierne korzyści farmakoekonomiczne. Część badaczy sugeruje wręcz, że oznaczanie BNP i NT-proBNP w tej grupie pacjentów ma jedynie znaczenie poznawcze i nie przekłada się na zmianę postępowania diagnostyczno-terapeutycznego. Celem niniejszej pracy jest przedstawienie wyników badań — zarówno tych, w których skupiono się na ocenie roli peptydów natriuretycznych w dokonaniu właściwego rozpoznania, jak i tych, w których analizowano potencjalne farmakoekonomiczne korzyści wykonania takiego oznaczenia. Choroby Serca i Naczyń 2011, 8 (4), 215–22

Idiopathic anaphylaxis

Anafilaksja idiopatyczna jest ciężką, zagrażającą życiu systemową lub uogólnioną natychmiastową reakcją nadwrażliwości o objawach podobnych/zbliżonych do innych postaci anafilaksji. Dotyczy ok. 30-60% przypadków u dorosłych i ok. 20% przypadków u dzieci. W patogenezie anafilaksji idiopatycznej istotną rolę mogą odgrywać zespół alfa-gal, mastocytoza, schorzenia przebiegające z aktywacją komórki tucznej oraz ukryte alergeny i kofaktory – wysiłek fizyczny, alkohol, leki. Objawy kliniczne anafilaksji idiopatycznej oraz postępowanie terapeutyczne są identyczne jak w anafilaksji o znanym czynniku sprawczym. W pracy omówiono epidemiologię anafilaksji, patomechanizm, diagnostykę oraz postępowanie terapeutyczne według wytycznych międzynarodowychIdiopathic anaphylaxis is a severe, life-threatening systemic or generalized immediate hypersensitivity reaction with symptoms similar to resembling other forms of anaphylaxis. It concers approximately 30-60% of cases in adults and 20% of cases in children. In the pathogenesis of idiopathic anaphylaxis, alpha-gal syndrome, mastocytosis, diseases associated with mast cell activation, and hidden allergens and cofactors -physical exertion, alcohol, drugs can play a significant role. The clinical manifestations of idiopathic anaphylaxis and therapeutic management are identical to those of anaphylaxis with a known causative agent. The paper discusses epidemiology of anaphylaxis, pathomechanism, diagnostics and therapeutic management according to international guidelines

The role of the nurse in the diagnostics of allergic diseases - skin tests

Choroby alergiczne są jednym z najczęściej występujących schorzeń współczesnej cywilizacji. Większość chorób z tej grupy ma charakter przewlekły i wymaga systematycznego leczenia. Leczenie alergii jest trudne i musi być wielokierunkowe. Podstawowym badaniem, które wykonuje się w przypadku chorób alergicznych, są testy skórne. Są one najbardziej skuteczną metodą służącą do wykrywania uczulenia i określenia uczulającego alergenu. W zależności od miejsca podania alergenu wyróżnia się: testy śródskórne, punktowe oraz naskórkowe - płatkowe. Znaczącą rolę w procesie diagnozowania pacjenta chorego na alergię odgrywa pielęgniarka, która powinna udzielić informacji choremu na temat istoty, celu i przebiegu przeprowadzonego testu diagnostycznego, a także prawidłowo założyć, odczytać i udokumentować wyniki przeprowadzonych testów. Poza tym sprawuje ona opiekę zarówno przed przeprowadzeniem testów, w ich trakcie, a także po ich wykonaniu. Problemy Pielęgniarstwa 2010; 18 (4): 523-528Allergic diseases are very common in the present civilization. Most of these disorders are chronic and systematic therapy is needed. Allergy treatment is difficult and should be multidirectional. The essential tests, used in the diagnostics of allergic diseases, are skin tests. They are the most effective method in allergy detection and allergen identification. In the dependence of the site of application skin tests are divided on intradermal, prick and epidermal - patch tests. The nurse plays an important role in the diagnostics of allergic patient. She should inform the patient about the aim and course of performed procedure, as well as correct applicate, read off and document the results of tests. Moreover, she takes care on the patient before, through and after performed tests. Nursing Topice 2010; 18 (4): 523-52

Iron Status and Inflammation in Early Stages of Chronic Kidney Disease

Background/Aims: One of the most common causes of anemia of chronic disease (ACD) is chronic kidney disease. The main pathomechanism responsible for ACD is subclinical inflammation. The key element involved in iron metabolism is hepcidin, however, studies on new indices of iron status are in progress.The aim of the study was to assess the iron status in patients in early stages of chronic kidney disease, iron correlation with inflammation parameters and novel biomarkers of iron metabolism. Methods: The study included 69 patients. Standard laboratory measurements were used to measure the iron status, complete blood count, fibrinogen, prothrombin index, C-reactive protein concentration (CRP), creatinine, urea, uric acid. Commercially available kits were used to measure high-sensitivity CRP, interleukin 6 (IL-6), hepcidin-25, hemojuvelin, soluble transferrin receptor (sTfR), growth differentiation factor-15 (GDF-15) and zonulin. Results: Absolute iron deficiency was present in 17% of the patients, functional iron deficiency was present in 12% of the patients. Functional iron deficiency was associated with significantly higher serum levels of fibrinogen, ferritin, transferrin saturation, total iron binding capacity, hepcidin and older age relative to patients with absolute iron deficiency. In comparison with patients without iron deficiency, patients with functional iron deficiency were older, with lower prothrombin index, higher fibrinogen, CRP, hsCRP, sTfR, GDF-15, urea and lower eGFR. Hepcidin was predicted by markers of inflammation:ferritin, fibrinogen and IL-6. Conclusion: Inflammation is correlated with iron status. Novel biomarkers of iron metabolism might be useful to distinguish iron deficiency anemia connected with inflammation and absolute iron deficiency

Involvement of Na+/H+ exchanger in desmopressin-induced platelet procoagulant response.

Desmopressin (DDAVP) action on platelets is associated with the development of procoagulant response but the underlying mechanism of this phenomenon is not known. We investigated whether this effect of DDAVP might be due to activation of plasma membrane Na+/H+ exchanger. The DDAVP-induced platelet procoagulant response, measured as phospholipid-dependent thrombin generation, was dose dependent and significantly weaker than that produced by collagen or monensin (mimics Na+/H+ antiport). Both the DDAVP- and collagen-produced procoagulant responses were less pronounced in the presence of EIPA, an Na+/H+ exchanger inhibitor. Flow cytometry studies revealed that in vitro treatment of platelets with DDAVP or collagen was associated with the appearance of both degranulated (and fragmented) and swollen cells. The DDAVP-evoked rise in size and granularity heterogeneity was similar to that produced by collagen or monensin and was not observed in the presence of EIPA. Using flow cytometry and annexin V-FITC as a probe for phosphatidylserine (PS) we demonstrated increased and uniform binding of this marker to all subsets of DDAVP-treated platelet population. The DDAVP-evoked PS expression was dose dependent, strongly reduced by EIPA and weaker than that caused by monensin or collagen. As judged by optical swelling assay, DDAVP in a dose dependent manner produced a rise in platelet volume. The swelling was inhibited by EIPA and its kinetics was similar to that observed in the presence of monensin. Electronic cell-sizing measurements showed an increase in mean platelet volume and a decrease in platelet count and platelet crit upon treatment with DDAVP. DDAVP elicited a slow (much slower than collagen) alkalinization of platelet cytosol. Altogether the data indicate an involvement of Na+/H+ exchanger in the generation of procoagulant activity in DDAVP-treated platelets