Figurative language impairment in aphasic patients: the effects of the type of figurative trope

Research conducted into the processing of figurative language by aphasic patients has repeatedly demonstrated that such patients experience difficulties comprehending nonliteral forms of discourse such as metaphors, idiomatic expressions, proverbs or irony (see, for example, The aim of the study described in this paper is thus verifying the effect of the type of figurative trope on the aphasic patients' figurative performance. In order to obtain a comprehensive examination of aphasic patients' figurative language skills, a figurative language battery was prepared, consisting of four parts, each of which focuses on a different figurative trope (idioms, metaphors, proverbs, and similes), and employs different tasks (multiple choice test presented on the computer screen, completion of the unfinished metaphorical expression presented orally). Idiomatic expressions used in the figurative battery varied with regard to their well/ill-formedness, opaqueness/transparency and non/literalness; metaphors varied along the dimension of conventionality (conventional vs. novel) and structure (nominal, verbal, adjectival); whereas similes differed in the number of words following the comparative word as. All of the proverbs used in the test were highly familiar, as confirmed in the norming study conducted with a group of Polish healthy adults. The obtained results confirm the essential role of various dimensions of idiom and metaphor variability in influencing figurative language processing in aphasia

Disease-related malnutrition (undernutrition and obesity) in patients hospitalized in the Department of Cardiology

Background: The nutritional status of patients with cardiovascular diseases significantly affects prognosis and disease course. Our study, which assessed the nutritional status of patients admitted to the Cardiology Department, revealed a substantial proportion of patients at risk of malnutrition, which increased with age. Malnutrition, including undernutrition and obesity, affects 40–60% of adult patients hospitalized in Europe and is associated with increased mortality, morbidity, length of hospital stay, and costs. Although malnutrition is a disease listed in the International Classification of Diseases and should be recognized and treated as such, it is rarely identified and even less often treated, which can have tragic consequences. In this analysis, we examined the nutritional status of adults hospitalized for cardiovascular diseases. Methods: Nutritional status was assessed using the Subjective Global Assessment (SGA), Nutritional Risk Screening 2002 (NRS 2002), Body Mass Index (BMI), and Waist-to-Hip circumference ratio (WHR). Additionally, serum concentrations of albumin, cholesterol, hemoglobin, and C-reactive protein were measured. This retrospective study included 95 consecutive patients. Results: Using NRS 2002 and SGA, the estimated risk of undernutrition was reported in 60% and 81% of patients, respectively. The prevalence of malnutrition (undernutrition, overweight, and obesity) increased with age, regardless of the scale used. Conclusions: Hospitalized patients with cardiovascular diseases should be screened for the risk of malnutrition using NRS 2002 or SGA. Although our data is based on a small number of patients, it should encourage clinicians to pay more attention to nutritional status to prevent malnutrition in at-risk patients

Wybrane cytokiny prozapalne, metabolizm kostny, osteoprotegeryna i ligand receptora aktywatora czynnika jądrowego-kB u dziewcząt z jadłowstrętem psychicznym

  Introduction: It has been indicated that disturbances in the production of certain pro-inflammatory cytokines might contribute to the development of osteoporosis in girls with anorexia nervosa (AN). The aim of the study was to determine whether girls with AN exhibited a relationship between IL-1β, IL-6, TNF-α, bone turnover markers (OC and CTx), OPG, sRANKL, and the OPG/sRANKL ratio. Material and methods: Serum IL-1β, IL-6, TNF-α, OC, CTx, OPG, and sRANKL were determined by ELISA in 59 girls with AN and in 17 healthy counterparts, aged 13 to 17 years. Results: Girls with AN showed significant reduction in body weight, BMI, BMI-SDS, and Cole index compared to the controls. These changes were associated with a significant increase in IL-1β, IL-6, TNF-α, OPG, and sRANKL concentrations and a decrease in bone markers and the OPG/sRANKL ratio. Significant negative correlations were found between BMI, the Cole index and CTx, OPG (girls with AN); between BMI and OC, CTx as well as the Cole index and CTx (the control group — C); between BMI, the Cole index and IL-β1, IL-6, TNF-α, CTx in all study participants (group AN+C). The combined group AN+C also exhibited positive correlation between BMI, the Cole index, and the OPG/sRANKL ratio. Girls with AN showed positive correlations between IL-1β, IL-6, and CTx as well as between TNF-α and sRANKL whereas the correlation between TNF-α and the OPG/sRANKL ratio was negative (IL-6 and IL-1β were identified to be independent predictors of CTx, TNF-α and IL-6 independently predicted sRANKL while TNF-α, IL-6, and IL-1β were independent predictors of the OPG/sRANKL ratio). The control participants exhibited negative correlations between IL-1β and OPG and positive correlations between IL-1β and sRANKL (IL-1β was found to be an independent predictor of OPG and sRANKL). In the AN+C group, IL-1β correlated negatively with OC and OPG and positively with sRANKL, while IL-6 and TNF-α positively correlated with CTx (IL-6 and TNF-α turned out to be independent predictors of CTx, IL-1β of OPG while IL-6, TNF-α, and IL-1β were independent predictors of sRANKL and the OPG/sRANKL ratio). Conclusions: The relationship between the nutritional status and IL-1β, IL-6, and TNF-α concentrations as well as bone status indicators seems to indicate that abnormalities observed regarding the concentrations of pro-inflammatory cytokines and bone remodelling in girls with AN might result from malnutrition. Correlations between IL-1β, IL-6, TNF-α, bone markers, OPG, its ligand sRANKL, and/or the OPG/sRANKL ratio suggest potential involvement of these cytokines in the mechanism underlying the lack of the expected bone mineral density increase in adolescent girls. (Endokrynol Pol 2015; 66 (4): 313–321)    Wstęp: Istnieją sugestie, że zaburzenia w wytwarzaniu niektórych cytokin prozapalnych mogą współuczestniczyć w mechanizmie prowadzącym do rozwoju osteoporozy u dziewcząt z jadłowstrętem psychicznym (AN, anorexia nervosa). Celem pracy było wykazanie, czy u dziewcząt z AN istnieje związek między IL-1β, IL-6, TNF-α, markerami obrotu kostnego (OC i CTx), OPG, sRANKL i wskaźnikiem OPG/sRANKL. Materiał i metody: U 59 dziewcząt z AN i 17 zdrowych w wieku 13–17 lat oceniono stężenia IL-1β, IL-6, TNF-α, OC, CTx, OPG i sRANKL w surowicy metodą ELISA. Wyniki: U dziewcząt z AN wykazano istotne obniżenie masy ciała, BMI, BMI-SDS oraz wskaźnika Cole’a w porównaniu z grupą kontrolną. Zmianom tym towarzyszył istotny wzrost stężeń IL-1β, IL-6, TNF-α, OPG, sRANKL przy zmniejszonym stężeniu markerów kostnych i obniżonym wskaźniku OPG/sRANKL. Wykazano ujemną korelację między wskaźnikami BMI i Cole’a a CTx i OPG (dziewczęta z AN); między BMI a OC i CTx oraz między wskaźnikiem Cole’a a CTx (grupa kontrolna — C); między wskaźnikami BMI i Cole’a a IL-β1, IL- 6, TNF-α, CTx (u wszystkich badanych łącznie: grupa AN+C). W grupie AN+C wskaźniki BMI i Cole’a korelowały ponadto dodatnio z wskaźnikiem OPG/sRANKL. U dziewcząt z AN stwierdzono dodatnią korelację między IL-1β i IL-6 a CTx, a także między TNF-α a sRANKL oraz ujemną między TNF-α a wskaźnikiem OPG/sRANKL (udokumentowano, że IL-6 i IL-1β są niezależnymi predyktorami dla CTx, TNF-α i IL-6 dla sRANKL a TNF-α, IL-6 i IL-1β dla wskaźnika OPG/sRANKL). W grupie kontrolnej IL-1β korelowała ujemnie z OPG a dodatnio z sRANKL (stwierdzono, że IL-1β jest niezależnym predyktorem dla OPG i sRANKL). W grupie AN+C zanotowano ujemną korelację między IL-1β a OC i OPG, a dodatnią między IL-1β a sRANKL oraz między IL-6 i TNF-α a CTx (wykazano, że IL-6 i TNF-α są niezależnymi predykatorami dla CTx, IL-1β dla OPG a IL-6, TNF-α i IL-1β dla sRANKL i wskaźnika OPG/sRANKL). Wnioski: Wykazana zależność między stopniem odżywienia a stężeniami IL-1β, IL-6, TNF-α oraz wykładnikami stanu kośćca może świadczyć o tym, że przyczyną obserwowanych nieprawidłowości w stężeniach badanych cytokin prozapalnych i przebudowie tkanki kostnej u dziewcząt z AN może być niedożywienie. Istnienie powiązań między stężeniami IL-1β, IL-6, TNF-α a markerami kostnymi, OPG, jej liganden sRANKL i/lub wskaźnikiem OPG/sRANKL wskazuje na możliwy współudział wymienionych cytokin w mechanizmie prowadzącym do braku oczekiwanego wzrostu gęstości mineralnej kości u dziewcząt w okresie dorastania. (Endokrynol Pol 2015; 66 (4): 313–321)

Risk of left atrial appendage thrombus in patients with atrial fibrillation and chronic kidney disease

Background: Atrial fibrillation (AF) and chronic kidney disease (CKD) are associated with an increased risk of ischemic stroke. The aim of this study was to compare the clinical characteristics, the incidence of left atrial appendage (LAA) thrombus and its predictors, and spontaneous echo contrast (SEC) in a population of patients with AF depending on estimated glomerular filtration rate (eGFR) values. Methods: This study included 1962 patients who underwent transesophageal echocardiographic examination (TEE) prior to cardioversion or ablation in the years 2014–2018 in three cardiac centers. Results: More than a quarter of AF patients had decreased eGFR ( < 60 mL/min/1.73 m2) and were characterized as a high-risk population, with more comorbidities, higher thromboembolic and bleeding risk compared to those with normal renal function. Oral anticoagulation (OAC) was prescribed in 97% and 93% of patients with decreased and normal eGFR, respectively, with a higher prevalence of prescribed non-vitamin K antagonist oral anticoagulants (NOACs). The incidence of LAA thrombus (24%, 9% and 4%) and SEC (25%, 25% and 19%) increases simultaneously with a decrease in eGFR ( < 30, 30–59 and > 60 mL/min/1.73 m2, respectively). Among patients prescribed reduced doses of NOAC, those with decreased eGFR were more often observed with LAA thrombus (10% vs. 2.5%). Non-paroxysmal AF, heart failure and previous bleeding were predictors of LAA thrombus, irrespective of eGFR value. CKD was the predictor of LAA thrombus in all patients including those with non-paroxysmal AF, males, without diabetes, without hypertension and with CHA2DS2-VASc < 2. Conclusions: Despite OAC, patients with concomitant AF and CKD remain at high risk for LAA thrombus formation

Pharmacotherapy of atrial fibrillation in COVID-19 patients

The coronavirus pandemic disease 2019 (COVID-19) has changed the face of contemporary medicine. However, each and every medical practitioner must be aware of potential early and late complications of COVID-19, its impact on chronic diseases — especially ones as common as atrial fibrillation (AF) — and the possible interactions between patients’ chronic medications and pharmacotherapy of COVID-19. Patients with AF due to comorbidities and, often, elderly age are assumed to be at a higher risk of a severe course of COVID-19. This expert consensus summarizes the current knowledge regarding the pharmacotherapy of AF patients in the setting of the COVID-19 pandemic. In general, anticoagulation principles in quarantined or asymptomatic individuals remain unchanged. Nevertheless, it is advisable to switch from vitamin K antagonists to non-vitamin K antagonist oral anticoagulants (NOACs) whenever possible due to their consistent benefits and safety with fixed dosing and no monitoring. Additionally, in AF patients hospitalized due to mild or moderate COVID-19 pneumonia, we recommend continuing NOAC treatment or to switching to low-molecular-weight heparin (LMWH). On the other hand, in severely ill patients hospitalized in intensive care units, intravenous or subcutaneous dosing is preferable to oral, which is why the treatment of choice is either LMWH or unfractionated heparin. Finally, particularly in critical scenarios, the treatment strategy in COVID-19 patients with AF should be individualized based on possible interactions between anticoagulants, antiarrhythmics, antivirals, and antibiotics. In this consensus, we also discuss how to safely perform COVID-19 vaccination in anticoagulated AF patients

Heart failure patients with a previous coronary revascularisation: results from the ESC-HF registry

Background: Coronary revascularization is common in heart failure (HF). Aims: Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalized for HF with or without a previous percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG). Methods: The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalization for HF-worsening) were assessed at one-year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalization was evaluated. Results: PCI/CABG-patients (32.7%) were more frequently male, smokers, had myocardial infarction, hypertension (HT), peripheral artery disease and diabetes. The non-PCI/CABG-patients more often had a cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; P=0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; P=0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction, use of antiplatelets; in the non-PCI/CABG-patients were: age, ACS at admission. Independent predictors of the SE in the PCI/CABG-patients were: diabetes, NYHA (New York Heart Association) class at admission, HT; in the non-PCI/CABG-patients were: NYHA class, haemoglobin at admission. Serum sodium concentration at admission was a predictor of the PE and the SE in both groups. Heart rate at discharge was a predictor of the PE and the SE in the non-PCI/CABG patients. Conclusions: The revascularized HF patients had a similar mortality and higher risk of death or hospitalizations at 12 months compared with the non-PCI/CABG-patients. The revascularized patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality.Background: Coronary revascularisation is common in heart failure (HF). Aim: Clinical characteristic and assessment of in-hospital and long-term outcomes in patients hospitalised for HF with or without a previous percutaneous coronary intervention (PCI) or a coronary artery bypass grafting (CABG). Methods: The primary endpoint (PE) (all-cause death) and the secondary endpoint (SE) (all-cause death or hospitalisation for HF-worsening) were assessed at one year in 649 inpatients of the ESC-HF Pilot Survey. Additionally, occurrence of death during index hospitalisation was evaluated. Results: PCI/CABG-patients (32.7%) were more frequently male, smokers, and had myocardial infarction, hypertension, pe¬ripheral artery disease, and diabetes. The non-PCI/CABG-patients more often had cardiogenic shock and died in-hospital. The PE occurred in 33 of the 212 PCI/CABG-patients (15.6%) and in 56 of the 437 non-PCI/CABG-patients (12.8%; p = 0.3). The SE occurred in 82 of the 170 PCI/CABG-patients (48.2%) and in 122 of the 346 non-PCI/CABG-patients (35.3%; p = 0.01). Independent predictors of the PE in the PCI/CABG-patients were: lower left ventricular ejection fraction and use of anti¬platelets; in the non-PCI/CABG-patients were: age and acute coronary syndrome at admission. Independent predictors of SE in the PCI/CABG-patients were: diabetes, New York Heart Association (NYHA) class at admission, and hypertension; in the non-PCI/CABG-patients they were: NYHA class and haemoglobin at admission. Serum sodium concentration at admission was a predictor of PE and SE in both groups. Heart rate at discharge was a predictor of PE and SE in the non-PCI/CABG patients. Conclusions: The revascularised HF patients had a similar mortality and higher risk of death or hospitalisation at 12 months compared with the non-PCI/CABG-patients. The revascularised patients had more comorbidities, while the non-PCI/CABG-patients had a higher incidence of cardiogenic shock and in-hospital mortality

Niewłaściwe przepisywanie zredukowanej dawki NOAC w praktyce klinicznej — wyniki Polskiego Rejestru Migotania Przedsionków (POL-AF) u hospitalizowanych pacjentów

Introduction. Prescribing non-vitamin K antagonist oral anticoagulants (NOACs) in a reduced or full dosage is important for providing patients with atrial fibrillation (AF) with efficacious and safe treatment. The study aimed to evaluate the administration frequency of reduced NOAC dosages against the guidelines and analysis of factors predisposing to such a choice in patients with AF included in the Polish Atrial Fibrillation (POL-AF) Registry. Material and methods. The study included 1003 patients with AF treated with reduced dosages of NOACs hospitalized in ten Polish cardiology centers from January to December 2019. The criteria for appropriately reduced NOAC dosages was a dosage reduction of individual NOAC from the clinical studies, which was the basis for their registration. Results. Among the 1003 patients who were treated with a reduced dosage of NOACs, inappropriately reduced dosages were observed in 242 patients (24.1%): in 120 patients (29.3%) treated with rivaroxaban, in 93 patients (33.8%) treated with apixaban and in 29 patients (9.1%) treated with dabigatran (p &lt; 0.0001). Independent predictors of the use of inappropriately reduced dosages of NOACs were heart failure (odds ratio [OR] 1.55, confidence interval [CI]: 1.08–2.22) and hospitalization due to cardiac implantable electronic device (CIED) implantations/reimplantations (OR 2.01, CI: 1.27–3.17). Factors diminishing the chances of using inappropriately reduced dosages of NOACs were age (OR 0.98, CI: 0.97–0.998), vascular disease (OR 0.29, CI: 0.21–0.40) and creatinine clearance (CrCl) &lt; 60 mL/min (OR 0.37, CI: 0.27–0.52). Conclusions. In the group of patients treated with a reduced dosage of NOAC, 24.1% of patients had an inappropriately reduced dosage prescription, most frequently the patients receiving apixaban and rivaroxaban. The factor predisposing to prescribing an inappropriately reduced dosage of NOAC was heart failure and hospitalization due to CIED implantation/reimplantation. Label adherence to NOAC dosage is important to improve clinical outcomes in AF patients, and further investigation is needed to assess the best dosage of NOACs in the AF population.Wstęp. Przepisywanie doustnych przeciwkrzepliwych leków niebędących antagonistami witaminy K (NOAC) w dawce zredukowanej lub pełnej jest istotne dla zapewnienia pacjentom z migotaniem przedsionków (AF) skutecznego i bezpiecznego leczenia. Celem badania było ocenienie częstości stosowania zredukowanych dawek NOAC w stosunku do wytycznych oraz analiza czynników predysponujących do takiego wyboru u pacjentów z AF zarejestrowanych w Polskim Rejestrze Migotania Przedsionków (POL-AF). Materiał i metody. Badanie obejmowało 1003 pacjentów z AF leczonych zredukowanymi dawkami NOAC, hospitalizowanych w 10 polskich ośrodkach kardiologicznych od stycznia do grudnia 2019 roku. Kryterium stosowania odpowiednio zredukowanych dawek NOAC była redukcja dawki indywidualnego leku NOAC na podstawie badań klinicznych, które były podstawą ich rejestracji. Wyniki. Spośród 1003 pacjentów leczonych zredukowanymi dawkami NOAC, nieodpowiednio zredukowane dawki zaobserwowano u 242 pacjentów (24,1%): u 120 pacjentów (29,3%) leczonych rywaroksabanem, u 93 pacjentów (33,8%) leczonych apiksabanem oraz u 29 pacjentów (9,1%) leczonych dabigatranem (p < 0,0001). Niezależnymi czynnikami predykcyjnymi stosowania nieodpowiednio zredukowanych dawek NOAC były: niewydolność serca (iloraz szans [OR] 1,55; przedział ufności [CI]: 1,08–2,22) oraz hospitalizacja związana z wszczepieniem/reimplantacją kardioelektronicznych urządzeń wszczepialnych (CIED) (OR 2,01; CI: 1,27–3,17). Czynnikiem zmniejszającym szanse na stosowanie nieodpowiednio zredukowanych dawek NOAC były: wiek (OR 0,98; CI: 0,97–0,998), choroba naczyniowa (OR 0,29; CI: 0,21–0,40) i klirens kreatyniny (CrCl) < 60 ml/min (OR 0,37; CI: 0,27–0,52). Wnioski. W grupie pacjentów leczonych zredukowaną dawką NOAC, 24,1% pacjentów miało nieodpowiednio przepisane dawki, najczęściej pacjenci otrzymujący apiksaban i rywaroksaban. Czynnikami predysponującymi do przepisywania nieodpowiednio zredukowanej dawki NOAC były niewydolność serca oraz hospitalizacja związana z wszczepieniem/reimplantacją CIED. Przestrzeganie zaleceń dotyczących dawek NOAC jest istotne dla poprawy wyników klinicznych u pacjentów z AF, konieczne jest również dalsze badanie w celu oceny optymalnej dawki NOAC w populacji z AF

Pharmacotherapy of heart failure A.D. 2023. Expert opinion of Working Group on Cardiovascular Pharmacotherapy, Polish Cardiac Society

Heart failure (HF) remains one of the most common causes of hospitalization and mortality among Polish patients. The position of the Section of Cardiovascular Pharmacotherapy presents the currently applicable options for pharmacological treatment of HF based on the latest European and American guidelines from 2021–2022 in relation to Polish healthcare conditions. Treatment of HF varies depending on its clinical presentation (acute/chronic) or left ventricular ejection fraction. Initial treatment of symptomatic patients with features of volume overload is based on diuretics, especially loop drugs. Treatment aimed at reducing mortality and hospitalization should include drugs blocking the renin-angiotensin-aldosterone system, preferably angiotensin receptor antagonist/neprilysin inhibitor, i.e. sacubitril/valsartan, selected beta-blockers (no class effect — options include bisoprolol, metoprolol succinate, or vasodilatory beta-blockers — carvedilol and nebivolol), mineralocorticoid receptor antagonist, and sodium-glucose cotransporter type 2 inhibitor (flozin), constituting the 4 pillars of pharmacotherapy. Their effectiveness has been confirmed in numerous prospective randomized trials. The current HF treatment strategy is based on the fastest possible implementation of all four mentioned classes of drugs due to their independent additive action. It is also important to individualize therapy according to comorbidities, blood pressure, resting heart rate, or the presence of arrhythmias. This article emphasizes the cardio- and nephroprotective role of flozins in HF therapy, regardless of ejection fraction value. We propose practical guidelines for the use of medicines, profile of adverse reactions, drug interactions, as well as pharmacoeconomic aspects. The principles of treatment with ivabradine, digoxin, vericiguat, iron supplementation, or antiplatelet and anticoagulant therapy are also discussed, along with recent novel drugs including omecamtiv mecarbil, tolvaptan, or coenzyme Q10 as well as progress in the prevention and treatment of hyperkalemia. Based on the latest recommendations, treatment regimens for different types of HF are discussed