Kwas moczowy w chorobach nerek, serca i naczyń

Zwiększone ryzyko występowania chorób metabolicznych, obserwowane w społeczeństwach zachodnich od połowy XX wieku, spowodowało konieczność identyfikacji czynników ryzyka, w szczególności łatwo oznaczalnych i modyfikowalnych. Takim czynnikiem ryzyka jest stężenie kwasu moczowego. W ostatnich latach wiele badań poświęcono związkom hiperurykemii z takimi komponentami zespołu metabolicznego, jak cukrzyca, otyłość i nadciśnienie tętnicze, a także innym chorobom układu sercowo-naczyniowego i nefropatii. Hiperurykemia wydaje się nie tylko predykatorem, ale także niezależnym czynnikiem ryzyka rozwoju zespołu metabolicznego, nadciśnienia tętniczego, śmierci sercowo-naczyniowej i choroby nerek. Celem niniejszej pracy było podsumowanie obecnego, opartego na dowodach, stanu wiedzy w tym zakresie. Choroby Serca i Naczyń 2011, 8 (1), 31–3

Prevalence and socioeconomic predictors of diagnosed and undiagnosed diabetes in oldest-old and younger Caucasian seniors: results from the PolSenior study

Introduction: Type 2 diabetes is one of the most common diseases in the aging population; however, data concerning correlates of diabetes in age-advanced individuals are limited. The study aimed to identify the socioeconomic correlates of diabetes in representative groups of oldest-old (≥ 85 years) and younger (65 to 84 years) Polish Caucasian seniors. Material and methods: PolSenior is a multicentre, population-based study conducted in Poland. Fasting plasma glucose levels and data from detailed medical questionnaires were obtained from 2128 male and 1961 female study participants aged ≥ 65 years. Multivariate logistic regression was used to identify significant socioeconomic risk factors for diabetes and undiagnosed diabetes. Results: The overall prevalence of diabetes in the study group was 21.9% (24.0% in women vs. 19.9% in men, p = 0.002), with an estimated weighted prevalence for all older Poles of 23.1%. Nearly one-fifth of cases were previously undiagnosed. Diabetes was more common in the younger elderly (65–84 years) than in the oldest-old (≥ 85 years) (23.4% vs. 18.6%, p < 0.001). The frequency of diabetes was higher in women than in men (24.0% vs. 19.9%, p < 0.002); however, men remained undiagnosed more commonly than women (4.7% vs. 3.3%, p = 0.029). The frequency of diabetes was higher among urban than rural dwellers (23% vs. 20.4%, p = 0.048). It was also related to marital status in women (p = 0.036) and occupation in men (p = 0.015). Multivariate logistic regression analysis revealed that the independent risk factors for diabetes were body mass index (BMI) and marital status in women, while in men it was solely BMI. Undiagnosed diabetes was more frequent among rural than city dwellers (4.8% vs. 3.5%, p = 0.03). In multivariate logistic regression analysis, only BMI and place of residence remained significant risk factors for being undiagnosed. Conclusions: The prevalence of diabetes in the ≥ 65-year-old population exceeds 20% but is lower in the oldest-old than in the younger elderly and is modified by socioeconomic factors. Many elderly individuals remain undiagnosed and do not benefit from the currently available therapy

Increased expression of mRNA specific for c-Met oncogene in human papillary thyroid carcinoma

Introduction: Papillary thyroid carcinoma (PTC) is a differentiated type of thyroid cancer and the most common type of carcinoma of this gland in the Polish population. PTC originates from the thyroid follicular epithelial cell and its molecular pathogenesis is still poorly understood. The aim of the study was to estimate the expression of mRNA, specific for the c-Met oncogene, in the tissue of human PTC, and to evaluate the possible correlation between the level of c-Met oncogene expression and such parameters as: patient’s age and gender, histopathological variants of the tumour and the assignment of patients to particular stages in the clinical staging system. Material and methods: The level of RNA expression which was measured in macroscopically unchanged thyroid tissue served as controls. Reverse transcription-polymerase chain reaction (RT-PCR) and densitometry analysis were employed for mRNA expression measurements, with the glyceraldehyde-3-phosphate dehydrogenase gene (GAPDH) as a control housekeeping gene. Results: Oncogene c-Met mRNA expression was evaluated for 18 cases of PTC (PTC follicular type – 8 cases, PTC classic type – 10 cases) and for the corresponding, macroscopically unchanged thyroid tissue. The mean expression of c-Met mRNA was significantly higher in PTC (three-fold), when compared to that found in macroscopically unchanged thyroid tissue. Conclusions: These findings are consistent with the possibility that the c-Met oncogene plays a crucial role in the carcinogenic process in the human thyroid

Grubość kompleksu błony wewnętrznej i środkowej tętnicy szyjnej i inne markery arteriosklerozy u pacjentów z cukrzycą typu 2 i chorobą przyzębia

Background: Periodontal disease is an inflammatory process which results in increased cardiovascular risk in patients with type 2 diabetes mellitus (DM2). It is not clear, however, whether periodontal inflammation may be associated with increased markers of atherosclerosis in these patients. Aim: This cross-sectional study aimed to answer the question of whether periodontal disease in DM2 is associated with increased markers and risk factors of atherosclerosis. Methods: One hundred and twenty one patients were included in the study. Sixteen were classified as periodontally healthy (BGI-H), 87 as having gingivitis (BGI-G), and 18 as having periodontitis with moderate bleeding (BGI-P2), according to the new Offenbacher classification. In all patients, intima-media thickness (IMT), pulse wave velocity (PWV), lipids, and C-reactive protein (CRP) were assessed. Results: Patients with periodontitis and gingivitis had a higher IMT value compared to the BGI-H group (0.804 &#177; 0.112 and 0.772 &#177; 0.127 vs 0.691 &#177; 0.151 mm, p < 0.01 and p < 0.05, respectively, odds ratio 5.25 for having IMT &#8805; 0.8 mm, 95% CI 1.1; 25). Patients from the BGI-P2 group also had higher blood pressure (BP) compared to the BGI-G and BGI-H groups, and higher CRP compared to the BGI-G group (4.6 &#177; 2.3 vs 3.8 &#177; 4.8 mg/L, p < 0.01). Lipid parameters and PWV were comparable in all the groups. Conclusions: Periodontal inflammation in patients with DM2 seems to be associated with increased IMT and BP, but not with greater arterial stiffness. These results support the hypothesis that periodontal disease may be associated with a vascular pathology. Kardiol Pol 2012; 70, 1: 7&#8211;13Wstęp: Choroba przyzębia jest procesem zapalnym, którego skutkiem u chorych na cukrzycę typu 2 jest zwiększone ryzyko sercowo-naczyniowe. Nie jest jednak jasne, w jakim stopniu zapalenie przyzębia powoduje zmiany w zakresie markerów arteriosklerozy u tych pacjentów. Cel: Celem pracy była odpowiedź na pytanie, czy choroba przyzębia u pacjentów z cukrzycą typu 2 wiąże się z pogrubieniem kompleksu błony wewnętrznej i środkowej tętnicy szyjnej (IMT) i zwiększeniem sztywności naczyń. Metody: Do badania włączono 121 chorych. Zgodnie z nową klasyfikacją Offenbachera 16 z nich zakwalifikowano jako periodontologicznie zdrowych (BGI-H), 87 jako pacjentów z zapaleniem dziąseł (gingivitis, BGI-G), a 18 jako osoby z zapaleniem przyzębia z krwawieniem średniego stopnia (BGI-P2). U wszystkich chorych oceniano IMT, prędkość fali tętna (PWV), stężenia lipidów i stężenie białka C-reaktywnego (CRP) w surowicy krwi. Wyniki: Chorzy z zapaleniem dziąseł i zapaleniem przyzębia charakteryzowali się większą wartością IMT w porównaniu z pacjentami ze zdrowym przyzębiem (0,804 &#177; 0,112 i 0,772 &#177; 0,127 v. 0,691 &#177; 0,151 mm, odpowiednio p < 0,01 i p < 0,05, iloraz szans dla IMT &#8805; 0.8 mm wynosił 5,25; 95% CI 1,1; 25). Pacjenci z grupy BGI-P2 charakteryzowali się także wyższym ciśnieniem tętniczym w porównaniu z grupą BGI-G i BGI-H, a także wyższym stężeniem CRP w surowicy w porównaniu z grupą BGI-G (4,6 &#177; 2,3 v. 3,8 &#177; 4,8 mg/l; p < 0,01). Parametry gospodarki lipidowej i PWV nie różniły się znamiennie między grupami. Wnioski: Zapalenie przyzębia u chorych na cukrzycę typu 2 wiąże się ze zwiększeniem IMT i ciśnienia tętniczego, ale nie ze zwiększoną sztywnością naczyń. Wyniki te wskazują na prawdziwość tezy, że proces zapalny przyzębia może korelować z patologią naczyniową. Kardiol Pol 2012; 70, 1: 7&#8211;1

Higher EU-TIRADS-Score Correlated with BRAF V600E Positivity in the Early Stage of Papillary Thyroid Carcinoma

The data demonstrating a correlation between sonographic markers of malignancy of thyroid cancer (TC) and its genetic status are scarce. This study aimed to assess whether the addition of genetic analysis at the preoperative step of TC patients’ stratification could aid their clinical management. The material consisted of formalin-fixed paraffin-embedded tumor fragments of 49 patients who underwent thyroidectomy during the early stages of papillary TC (PTC). Tumor DNA and RNA were subjected to next-generation sequencing (NGS) on Ion Proton using the Oncomine™ Comprehensive Assay panel. We observed a significant correlation between BRAF V600E and a higher EU-TIRADS score (p-value = 0.02) with a correlation between hypoechogenicity and taller-than-wide tumor shape in analysed patients. There were no other significant associations between the identified genetic variants and other clinicopathological features. For TC patient’s stratification, a strong suspicion of BRAF V600E negativity in preoperative management of TC patients could limit the over-treatment of asymptomatic, very low-risk, indolent disease and leave room for active surveillance

Diagnosis and treatment of thyroid cancer in adult patients — Recommendations of Polish Scientific Societies and the National Oncological Strategy. 2022 Update [Diagnostyka i leczenie raka tarczycy u chorych dorosłych — Rekomendacje Polskich Towarzystw Naukowych oraz Narodowej Strategii Onkologicznej. Aktualizacja na rok 2022]

The guidelines Thyroid Cancer 2022 are prepared based on previous Polish recommendations updated in 2018. They consider international guidelines — American Thyroid Association (ATA) 2015 and National Comprehensive Cancer Network (NCCN); however, they are adapted according to the ADAPTE process. The strength of the recommendations and the quality of the scientific evidence are assessed according to the GRADE system and the ATA 2015 and NCCN recommendations. The core of the changes made in the Polish recommendations is the inclusion of international guidelines and the results of those scientific studies that have already proven themselves prospectively.These extensions allow de-escalation of the therapeutic management in low-risk thyroid carcinoma, i.e., enabling active surveillance in papillary microcarcinoma to be chosen alternatively to minimally invasive techniques after agreeing on such management with the patient. Further extensions allow the use of thyroid lobectomy with the isthmus (hemithyroidectomy) in low-risk cancer up to 2 cm in diameter, modification of the indications for postoperative radioiodine treatment toward personalized approach, and clarification of the criteria used during postoperative L-thyroxine treatment. At the same time, the criteria for the preoperative differential diagnosis of nodular goiter in terms of ultrasonography and fine-needle aspiration biopsy have been clarified, and the rules for the histopathological examination of postoperative thyroid material have been updated. New, updated rules for monitoring patients after treatment are also presented.The updated recommendations focus on ensuring the best possible quality of life after thyroid cancer treatment while maintaining the good efficacy of this treatment