Advanced chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases and the fourth cause of death in the world. Its advanced forms (severe - in case of FEV1 indicator below 50% of the norm and very severe — below 30%) usually lead to respiratory disability and premature death. The prognoses of those suffering from severe forms of COPD are no different from patients with lung cancer. The course of the disease is highly influenced by its exacerbation and co-morbidities, such as cardiovascular diseases, diabetes, lung cancer and peptic ulcer. Treatment aims at stopping the progress of disease, preventing its exacerbation and relieving tiresome symptoms, mainly dyspnoea, chronic cough and decreasing tolerance of effort.Chronic obstructive pulmonary disease (COPD) is one of the most common chronic diseases and the fourth cause of death in the world. Its advanced forms (severe - in case of FEV1 indicator below 50% of the norm and very severe - below 30%) usually lead to respiratory disability and premature death. The prognoses of those suffering from severe forms of COPD are no different from patients with lung cancer. The course of the disease is highly influenced by its exacerbation and co-morbidities, such as cardiovascular diseases, diabetes, lung cancer and peptic ulcer. Treatment aims at stopping the progress of disease, preventing its exacerbation and relieving tiresome symptoms, mainly dyspnoea, chronic cough and decreasing tolerance of effort

Zaawansowana postać przewlekłej obturacyjnej choroby płuc

Przewlekła obturacyjna choroba płuc (POChP) jest jedną z najczęstszych przewlekłych chorób i czwartą przyczyną zgonów na świecie. Zaawansowane postaci (ciężka - w przypadku wskaźnika FEV1 poniżej 50% należnej normy - i bardzo ciężka - poniżej 30%) z reguły prowadzą do inwalidztwa oddechowego i przedwczesnego zgonu. Rokowanie chorych na zaawansowane postaci POChP nie różni się od rokowania u chorych na raka płuca. Na przebieg choroby znaczący wpływ mają jej zaostrzenia oraz schorzenia współistniejące, takie jak choroby układu sercowo-naczyniowego, cukrzyca, rak płuca i choroba wrzodowa. Cele leczenia obejmują: zahamowanie postępu choroby, zapobieganie zaostrzeniom i uśmierzanie dokuczliwych objawów, do których należą przede wszystkim duszność, przewlekły kaszel i zmniejszająca się tolerancja wysiłku

The incidence of chronic obstructive pulmonary disease in advanced non-small cell lung cancer patients

Background and aim. Lung cancer is one of the most common tumours and the cause of cancer-related deaths in European countries. In the past few years, a significant morbidity of chronic obstructive pulmonary disease (COPD) has been noticed in this group of patients. Cigarette smoking is the strongest risk factor for both conditions. The palliative care of lung cancer patients is often based solely on the tumour symptoms' management, whereas some patients would benefit from the combined treatment including the treatment for COPD. The aim of this study was to evaluate the incidence of COPD in advanced (TNM = IIIB and IV) non-small cell lung cancer (NSCLC) patients. Material and methods. The study was a retrospective analysis. One hundred four patients (28 women and 76 men, aged from 47 to 74 years, mean: 63.2 years) with advanced NSCLC were included in the study. Results. Chronic obstructive pulmonary disease (according to GOLD criteria) was diagnosed in 26 cases (25%), including 1 mild, 17 moderate and 8 with severe or very severe disease. Chronic obstructive pulmonary disease was significantly more frequent in squamous cell lung carcinoma in comparison to other types (p = 0.009). Conclusions. Coexistence of lung cancer and COPD is frequent. Therefore, it is important to consider the treatment for COPD in palliative care of advanced lung cancer patients.Background and aim. Lung cancer is one of the most common tumours and the cause of cancer-related deaths in European countries. In the past few years, a significant morbidity of chronic obstructive pulmonary disease (COPD) has been noticed in this group of patients. Cigarette smoking is the strongest risk factor for both conditions. The palliative care of lung cancer patients is often based solely on the tumour symptoms' management, whereas some patients would benefit from the combined treatment including the treatment for COPD. The aim of this study was to evaluate the incidence of COPD in advanced (TNM = IIIB and IV) non-small cell lung cancer (NSCLC) patients. Material and methods. The study was a retrospective analysis. One hundred four patients (28 women and 76 men, aged from 47 to 74 years, mean: 63.2 years) with advanced NSCLC were included in the study. Results. Chronic obstructive pulmonary disease (according to GOLD criteria) was diagnosed in 26 cases (25%), including 1 mild, 17 moderate and 8 with severe or very severe disease. Chronic obstructive pulmonary disease was significantly more frequent in squamous cell lung carcinoma in comparison to other types (p = 0.009). Conclusions. Coexistence of lung cancer and COPD is frequent. Therefore, it is important to consider the treatment for COPD in palliative care of advanced lung cancer patients

Postawy wobec palenia tytoniu wśród studentów I i VI roku medycyny z rocznika studiów 2002-2008

Wstęp: Zjawisko palenia tytoniu wśród studentów medycyny wskazuje, że studia medyczne nie stanowią wystarczającej bariery przed kontynuowaniem, a nawet rozpoczynaniem palenia. Celem badania była ocena postaw wobec palenia wśród studentów I i VI roku Wydziału Lekarskiego Gdańskiego Uniwersytetu Medycznego z rocznika studiów 2002-2008. Materiał i metody: Wśród studentów rocznika studiów 2002-2008 dwukrotnie, na I i VI roku, rozprowadzono ankietę zawierającą pytania na temat kwestii związanych z paleniem tytoniu. W ankiecie adresowanej do studentów VI roku zawarto dodatkowe pytania, umożliwiające ocenę zmian w postawach studentów wobec palenia w trakcie studiów, a także poznanie opinii respondentów na temat nauczania na studiach rozpoznawania i leczenia zespołu uzależnienia od tytoniu (ZUT) oraz ich samooceny posiadanej wiedzy w tym zakresie. W badaniu wzięło udział 287 studentów I roku i 175 studentów VI roku badanego rocznika. Wyniki: Wraz z końcem studiów studenci istotnie rzadziej regularnie palili papierosy niż na I roku (13% v. 21%; p = 0,022), jednak co piąta paląca osoba (20%) zaczęła palić papierosy w trakcie studiów medycznych. Odsetek palaczy, którzy palili bez większego skrępowania, był istotnie niższy, niż na początku studiów (31% v. 70%; p = 0,0006), stwierdzono także znacząco wyższe odsetki palaczy deklarujących chęć porzucenia nałogu (91% v. 61%; p = 0,013) oraz codziennych palaczy, którzy chcieliby poddać się leczeniu uzależnienia od tytoniu (54% v. 22%; p = 0,001). Ponad połowa studentów VI roku przyznała, że nie ma żadnej wiedzy na temat rozpoznawania i leczenia ZUT lub ich wiedza na ten temat jest bardzo słaba lub słaba (57%). Aż 43% badanych stwierdziło, że studia medyczne w ogóle nie były dla nich źródłem wiedzy o ZUT. Wnioski: Studia medyczne wpływają na pozytywne zmiany postaw studentów wobec palenia tytoniu. Jednak część osób podejmuje palenie na studiach, co sugeruje dominujący udział czynników genetycznych nad środowiskowymi w rozpoczynaniu palenia w tym okresie życia. W opinii przyszłych lekarzy studia medyczne nie są wystarczającym źródłem wiedzy o ZUT.Introduction: The prevalence of smoking among medical students indicates that studying medicine is an insufficient protection from tobacco use. The aim of the study was an analysis of medical students’ attitudes towards smoking at the first and sixth year of their studies. Material and methods: A questionnaire on tobacco smoking was distributed among medical students of the study year 2002-2008 at the first and sixth year of their studies. The questionnaire used on the sixth year students included additional questions designed to assess changes in their attitudes towards smoking during their studies, to ask their opinion of the teaching of diagnostics and treatment of tobacco dependence (TD), and to discover how they evaluated their knowledge of the issue. The numbers of students who participated at the two points of the study were 287 and 175 respectively. Results: Students in their sixth year significantly less frequently smoked cigarettes regularly than those starting their medical education (13% v. 21%; p = 0.022). However, 20% of smokers started smoking during their studies. The proportion of smokers saying they were not embarrassed by their smoking habit was significantly lower among sixth-year students compared to first-year students (31% v. 70%; p = 0.0006), as were the numbers who said they wanted to quit smoking (91% v. 61%). Those who wished to undergo treatment for TD (54% v. 22%) were significantly higher among sixth year students group (p = 0.013 and p = 0.001, respectively). More than half (57%) the sixth-year students claimed that they had no knowledge of the diagnostics and treatment of TD, or that their knowledge on this issue was poor or very poor. In the opinion of 43% of students, the medical curriculum was not a good source of knowledge on TD. Conclusions: Medical studies induce positively students’ attitudes towards smoking. However, a proportion of individuals start smoking during studies, which may suggest dominance of genetic influences on smoking initiation in this period of life. In sixth-year students’ opinion, medical studies are not a sufficient source of knowledge on TD

Coexistance of lung cancer and chronic obstructive pulmonary disease

Wstęp. Celem niniejszego opracowania było określenie częstości występowania przewlekłej obturacyjnej choroby płuc (POChP) u chorych na zaawansowanego raka płuca. Materiał i metody. Badaniem objęto kolejnych 51 chorych na zaawansowanego (stopień IIIB i IV) raka płuca - 13 kobiet (25%) i 38 mężczyzn (75%) w wieku 40-80 lat (średnia wieku: 63 lata). Wyniki. Wśród 51 chorych na zaawansowanego raka płuca w 18 przypadkach (35%) rozpoznano POChP. W tej grupie u niemal 3/4 osób (72%) występowała umiarkowana, a u 28% ciężka i bardzo ciężka postać choroby. Związek między POChP a rakiem płuca był najsilniejszy u chorych na raka płaskonabłonkowego (współczynnik korelacji Spearmana: r = 0,43; różnica w porównaniu z pozostałymi typami: p = 0,002). Wykazano, że współwystępowanie raka płuca i POChP wiązało się z większym narażeniem na dym tytoniowy, jednak zależność ta nie osiągnęła znamienności statystycznej (p = 0,072). Nie stwierdzono korelacji między obecnością POChP w badanej grupie a innymi klinicznymi cechami, takimi jak wiek, płeć i zaawansowanie choroby nowotworowej. Wnioski. Współwystępowanie raka płuca i POChP jest częste. Wydaje się, że uwzględnienie współistniejących pneumonologicznych schorzeń w opiece paliatywnej nad chorymi w końcowej fazie choroby nowotworowej pozwoliłoby poprawić jakość ich życia.Background. The aim of the study was to evaluate the frequency of coexistance of lung cancer and chronic obstructive pulmonary disease. Material and methods. Fifty one patients (13 women and 38 men, aged from 40 to 80 years, range: 63 years) with diagnosed advanced lung cancer (stage IIIB and IV) were included into the study. Results. The chronic obstructive pulmonary disease was diagnosed in 18 cases (35%), including 72% moderate and 28% with severe and very severe disease. The chronic obstructive pulmonary disease was significantly more frequent in squamous cell lung carcinoma in comparison to other subtypes (p = 0.002). There was also a tendency to coexistence of lung cancer and the chronic obstructive pulmonary disease in patients with higher exposure to cigarette smoke (p = 0.072).Conclusion. Coexistence of lung cancer and the chronic obstructive pulmonary disease is frequent, thus it is important to include treatment for the chronic obstructive pulmonary disease in palliative care of advanced lung cancer patients

Perinatal and neonatal outcome in patients with preeclampsia

Objectives: Preeclampsia (PE) affects 2–5% of pregnant women. Hypertensive disorders of pregnancy are associated with adverse maternal and perinatal outcomes. Material and methods: This study included 88 women showing gestational hypertension (GH) or PE symptoms, and their newborns. Results: The rate of FGR was 43% for mothers with PE, compared to 8% with GH. The association was significant, p = < 0.001 but with moderate strength, Cramer’s V = 0.40. The risk of FGR increased nine times when PE occurred, as the odds ratio was 9.25 (CI: 2.46–34.83), p = 0.001. PE was associated with FGR risk if delivery time was less than 34 weeks compared to a delivery time of more than 34 weeks. This was 82% of FGR cases for < 34 weeks, compared with 35% of cases in > 34 group, (p = 0.001; Cramer’s V = 0.50). PE was also associated (p = 0.01, Cramer’s V = 0.27) with the type of delivery, as the caesarean section rate was 74%, compared to 50% in the GH group. This made it three times higher the likelihood of delivery by caesarean section, as the odds ratio was 3.10 (CI: 1.24–7.75), p=0,02. Delivery time was significantly (p < 0.001) shortened to 38 weeks (27–41), compared to 40 weeks (38–42) GH mothers. There was no distinction in median age for PE and GH mothers (p = 0.124). The overall clinical status of neonates was proportional despite the mother’s PE. The sum of Apgar points in the first, and then the second to third minute, did not differ significantly, p = 0.370 and 0.560, respectively. The number of peripheral blood platelets and leucocytes was not reduced (p = 0.821 and 0.534) in infants when the mother suffered from PE. Conclusions: The prediction of adverse maternal outcomes from hypertensive diseases of pregnancy is key to optimal management, including the timing of delivery and planning for the most appropriate place of care.

Cytokine Imprint in Preeclampsia

The hallmark of preeclampsia (PE) is a shift toward persistent inflammatory response, accompanied by endothelial dysfunction. The driving forces in PE are proinflammatory cytokine and growth factors, in parallel with reduced functionality of anti-inflammatory effectors, like regulatory T cells are observed. Unfortunately, no conclusive mechanism underlying preeclampsia has been identified. For this reason, research on preeclampsia is needed to provide a state of the art understanding of the pathophysiology, identification of new diagnostics tools and the development of targeted therapies. The 68 patients were divided into three groups: gestational hypertension (GH) group (n = 19) and PE group (n = 28) and a control group (n = 21). We have tested a set of 53 cytokines, chemokines and growth factors in preeclampsia and gestational hypertension, and then compared them with normal pregnancies. Using a diagnostic test assessment characteristic parameters (IL-22, MDC/CCL22, IL-2/IL-4 ratio) have been identified and cut-off values have been proposed to diagnose preeclampsia. All parameters had high negative or positive predictive values, above 80%. In conclusion, we have proposed a potential set of immune parameters to diagnose preeclampsia

Oxygen therapy with high-flow nasal cannulas in children with acute bronchiolitis

Acute bronchiolitis is a common disease in children below 24 months of age. The most common aetiology of this disease is a respiratory syncytial virus infection. Since there is no effective treatment for bronchiolitis, supportive therapy alleviating symptoms and preventing respiratory failure is recommended. Oxygen therapy and appropriate nutrition during the disease are considered effective, particularly in severe cases. The choice of oxygen support is crucial. The present paper discusses oxygen therapy using high-flow nasal cannulas. Moreover, the safety of the method, its adverse side effects and practical pre-treatment guidelines are discussed.Acute bronchiolitis is a common disease in children below 24 months of age. The most common aetiology of this disease is a respiratory syncytial virus infection. Since there is no effective treatment for bronchiolitis, supportive therapy alleviating symptoms and preventing respiratory failure is recommended. Oxygen therapy and appropriate nutrition during the disease are considered effective, particularly in severe cases. The choice of oxygen support is crucial. The present paper discusses oxygen therapy using high-flow nasal cannulas. Moreover, the safety of the method, its adverse side effects and practical pre-treatment guidelines are discussed

Medical Students’ Attitudes towards Tobacco Smoking at the First and Sixth Year of Their Studies 2002–2008

Introduction: The prevalence of smoking among medical students indicates that studying medicine is an insufficient protection from tobacco use. The aim of the study was an analysis of medical students’ attitudes towards smoking at the first and sixth year of their studies. Material and methods: A questionnaire on tobacco smoking was distributed among medical students of the study year 2002–2008 at the first and sixth year of their studies. The questionnaire used on the sixth year students included additional questions designed to assess changes in their attitudes towards smoking during their studies, to ask their opinion of the teaching of diagnostics and treatment of tobacco dependence (TD), and to discover how they evaluated their knowledge of the issue. The numbers of students who participated at the two points of the study were 287 and 175 respectively. Results: Students in their sixth year significantly less frequently smoked cigarettes regularly than those starting their medical education (13% v. 21%; p = 0.022). However, 20% of smokers started smoking during their studies. The proportion of smokers saying they were not embarrassed by their smoking habit was significantly lower among sixth-year students compared to first-year students (31% v. 70%; p = 0.0006), as were the numbers who said they wanted to quit smoking (91% v. 61%). Those who wished to undergo treatment for TD (54% v. 22%) were significantly higher among sixth year students group (p = 0.013 and p = 0.001, respectively). More than half (57%) the sixth-year students claimed that they had no knowledge of the diagnostics and treatment of TD, or that their knowledge on this issue was poor or very poor. In the opinion of 43% of students, the medical curriculum was not a good source of knowledge on TD. Conclusions: Medical studies induce positively students’ attitudes towards smoking. However, a proportion of individuals start smoking during studies, which may suggest dominance of genetic influences on smoking initiation in this period of life. In sixth-year students’ opinion, medical studies are not a sufficient source of knowledge on TD