Impact of health education on adherence to clopidogrel and clinical effectiveness of antiplatelet treatment in patients after myocardial infarction

Non-adherence rates to antiplatelet drugs in patients with acute myocardial infarction (AMI) range from 13% to 60%. We aimed to evaluate whether individual health education can improve adherence to treatment with clopidogrel in patients after AMI. This was a prospective, single-center, randomized clinical trial with a 12-month follow-up. Patients with AMI treated with percutaneous coronary intervention (PCI) were enrolled. The primary endpoint was defined as non-adherence to clopidogrel during follow-up (drug availability ≤ 80%). Secondary endpoints included platelet function assessment, adverse cardiovascular (CV) events (CV death, PCI for ACS, unscheduled CV hospitalization). There were 191 patients enrolled in the study and divided into two groups: the individual education (IE) group (100 patients) and the standard treatment (ST) group (91 patients). Adherence to the treatment with clopidogrel based on the data from the National Health Fund did not differ significantly between the IE and ST groups [76.7% (30.7–99.7%) v. 84.4% (46.5–99.7%); p = 0.25]. There was a substantial difference in the prevalence of unscheduled CV hospitalizations between both groups, IE and ST respectively [22 (22.0%) v. 10 (11.0%); p = 0.042]. The rate of CV death and ACS treated with PCI during follow-up was low and did not differ between groups. In conclusion, the program of individual health education did not improve adherence to treatment with clopidogrel. The expected benefits of medication are not achievable at current levels of adherence. The self-reported adherence assessment is unreliable and cannot be used for effective treatment guidance

Zorganizowana skrzeplina w lewej komorze powstała po zabiegu przezskórnej angioplastyki wieńcowej mimo stosowanej podwójnej terapii przeciwpłytkowej

Myocardial infarction is an acute condition which can lead to many complications in a postinfarct period (MI, myocardial infarction). Left ventricular thrombus formation after successful primary percutaneous coronary intervention (PCI) with stenting and treating with dual antiplatelet therapy nowadays is a less common finding especially in absence of severe left ventricular dysfunction associated with MI. Case of 70-year-old male who was admitted to the Emergency Department with severe MI treating with successful primary PCI with stenting and dual antiplatelet therapy with a new unexpected finding of thrombus in the left ventricular apex observed in control of the echocardiography examination during hospitalisation despite dual antiplatelet therapy.Zawał serca jest stanem ostrym, który może prowadzić do licznych powikłań we wczesnym okresie pozawałowym.Występowanie skrzepliny w lewej komorze u pacjentów po skutecznej pierwotnej przezskórnej angioplastyce (PCI) z implantacją stentu i zastosowaniu podwójnej terapii przeciwpłytkowej (DAPT) w obecnych czasach jest mniej powszechnym zjawiskiem, zwłaszcza u osób bez ciężkiej pozawałowej dysfunkcji mięśnia lewej komory. Zaprezentowano przypadek 70-letniego mężczyzny, przyjętego do kliniki z prezentacją ostrego zespołu wieńcowego leczonego skuteczną pierwotną PCI z implantacją stentu i zastosowaniem DAPT, u którego, mimo zastosowanej terapii, w kolejnych badaniach echokardiograficznych podczas hospitalizacji obserwowano skrzeplinę w koniuszku lewej komory

p21/Wafl/Cipl cellular expression in chronic long-lasting hepatitis C: correlation with HCV proteins (C, NS3, NS5A), other cell-cycle related proteins and selected clinical data.

Studies indicate that proteins of hepatitis C virus (HCV) disturb expression of cell-cycle-related proteins. A disturbed cell-cycle control is a hepatocellular carcinoma (HCC) risk factor in patients with HCV-related liver damage. The present study aimed to analyse the cellular expression of p21/Wafl/Cipl (p21) in long-lasting chronic hepatitis C (CH-C), its correlation with the key oncogenic HCV proteins (C, NS3, NS5A), other cell-cycle-related proteins (PCNA, Ki-67, cyclin D1, p53) and selected clinical data. Archival liver biopsies, obtained from patients with CH-C, normal livers, and hepatocellular carcinoma (HCC) specimens were analysed by immunocytochemistry and ImmunoMax technique. In CH-C overexpression of p21 protein was demonstrated. Positive correlations of p21 protein expression in CH-C involved age of the patients, grading, and liver steatosis. Moreover, expression of p21 correlated significantly with expression of p53 protein, of D1 cyclin and Ki-67. Although Ki-67 antigen was related to p21 expression, only Ki-67 expression proved to be directly related to liver staging. Expression of the NS3 protein, which prevailed in CH-C patients, manifested correlation with p21 expression, and that of cyclin D1. In presence of preserved potential for regeneration, overexpression of p21 indicates inhibition of cell cycle in hepatocytes, which probably plays a protective role for the chronically damaged cells. Out of the three HCV proteins only NS3 seems to affect control of p21 protein expression in in vivo infection. Nevertheless, the studies indicate that neither expression of p21 protein nor that of viral NS3 protein can serve as a marker of progression of CH-C to HCC in vivo

p53 immunocytochemistry and TP53 gene mutations in patients with chronic hepatitis C virus (HCV) infection.

Chronic infection with hepatitis C virus (HCV) is regarded as a risk factor for hepatocellular carcinoma (HCC), mostly in patients with liver cirrhosis. Present study aimed at evaluation of cellular expression of p53 protein, genetic TP53 changes in liver samples and anti-p53 in serum of patients with chronic hepatitis C virus infection. The expression of p53 protein were analysed by immunocytochemistry in liver biopsies from adult patients with chronic, long-lasting hepatitis C. In order to detect TP53 mutations, PCR/SSCP and sequencing were performed. Antibodies against p53 in serum were determined using enzyme immunoassay (ELISA).In two out of 14 examined patients TP53 point mutations were detected in the liver samples. In the first patient, a substitution of C to T was demonstrated in position 1 of the codon 250, resulting in substitution of proline by serine. The other patient carried a substitution of C to G in position 13274 of the intron 6. The patient carrying mutation in the codon 250 demonstrated morphological traits of liver cirrhosis and had high number of p53-immunoreactive cell nuclei in tissue. None of the patients manifested elevated titres of serum anti-p53. In the liver, significant positive correlations were disclosed between expression of p53 on one hand and grading and staging on the other. A negative correlation was disclosed between cellular expression of p53 and duration time of infection. In conclusions, genetic changes in TP53 can be detected also in non-neoplastic lesions linked to chronic HCV infection

Effectiveness of therapeutic education in patients with myocardial infarction

Introduction. Notwithstanding the development of modern diagnostic-therapeutic techniques, cardiovascular diseases still pose a grave health, social, and economic issue. Patients hospitalised for acute coronary syndrome should, in addition to establishing an optimal pharmacotherapy, be made aware of how to prevent this disease and recognise it using its typical symptoms and signs. Objective. The objective of the study was to evaluate the effectiveness of educational intervention based on educational brochures in patients with myocardial infarction with regard to socio-demographic factors and baseline patients’ knowledge. Material and methods. The single-centre, prospective, observational study was conducted in a cohort of 248 patients with myocardial infarction (women n = 72, men n = 176), hospitalised between May 2015 and July 2016. Consistently with the results of univariate analysis, multivariate analysis identified age (–3.73/10 years; p < 0.0006) and the level of education (10.37; p < 0.0001) as independent factors influencing patients’ prehospital knowledge. Results. According to multivariate analysis of the level of knowledge following the educational intervention, the only factors affecting the process of learning were age (–2.04/10 years; p < 0.03) and remaining in a steady relationship (9.7; p = 0.0003). Among factors influencing the increase of knowledge, only the level of education was of statistical significance (–6.09; p < 0.02). Conclusions. The educational brochure proved to be an effective tool for therapeutic education, allowing minimisation of the disparities between the examined groups and improvement of the breadth of patients’ knowledge

Immunohistochemical and hybridocytochemical study on ghrelin signalling in the rat seminiferous epithelium.

The results of presented study demonstrate expression of ghrelin, its functional receptor GHSR-1a and their genes in spermatogenic cells of rat testis suggesting their functioning within seminiferous epithelium. The immunohistochemical and hybrydocytochemical expression, of proteins and transcripts, was estimated taking into account the cycle of seminiferous epithelium and phases of spermatogenesis. Both transcripts and ghrelin was found to show nuclear expression and scarcely cytoplasmic. Expression of genes for ghrelin and GHSR-1a was shown in early spermatocytes and round spermatids representing transcriptional phases of meiosis and spermiogenesis. Ghrelin was evidenced to show nuclear expression in two stage-specific windows, in late spermatogonia, in spermatocytes up to early pachytenes, and again in spermatids of acrosome and early maturation phase of spermiogenesis. In late pachytenes, secondary spermatocytes, round spermatids, maturing spermatids and spermatozoa the reaction is lacking. With two types of antibodies against the GHSR-1a used the two different patterns of immunostaining was evidenced suggesting two isoforms of GHSR-1a. The first evidenced GHSR-1a in cytoplasm of spermatocytes, cell membrane and acrosomes of spermatids, Sertoli cell processes and heads of spermatozoa. With second type of antibodies the immunostaining marks all steps of evolution of acrosome in spermatids. It is believed that site of ghrelin expression in seminiferous epithelium may indicate its role in local regulations, not excepting the intracellular signalling. Immunostaining pattern for GHSR-1a seems to suggest both its participation in the cross-talk among the cells and also process of furnishing gametes with GHSR-1a for its response to ghrelin in seminal plasma or female reproductive tract

Intracellular expression of the proliferative marker Ki-67 and viral proteins (NS3, NS5A and C) in chronic, long lasting hepatitis C virus (HCV) infection.

Hepatitis C virus (HCV) continues to represent the main causative agent of the hepatitis, which leads to chronic transformation of the process in 60-80% individuals. It remains unclear how far cellular expression of HCV proteins in vivo may represent an index of progression of the disease and of proliferative activity in the liver in chronic hepatitis C. Aim of the studies included detection and subcellular localization of three HCV proteins (NS3, NS5A and C) in liver biopsies from adults (n=19) with chronic, long lasting hepatitis C as related to hepatocyte proliferative activity. The immunocytochemical ABC (avidin biotin-peroxidase complex) technique was applied, alone or associated with the ImmunoMax technique. Results of the immunocytochemical tests were compared to histological alterations in liver biopsies, proliferation index and with selected clinical data. A significantly higher expression of NS3 protein was noted, as compared to expressions of NS5A and C proteins. In all the patients, cytoplasmic localization of all proteins dominated over nuclear localization (p0.05). At the level of electron microscopy, protein localization in endoplasmic reticulum (ER) membranes, mitochondria, perinuclear region and/or in hepatocyte cell nucleus was observed. No direct relationships could be demonstrated between expressions of HCV proteins and of Ki-67 antigen. No correlations could also be demonstrated between cellular expression of any HCV protein on one hand and grading or staging, alanine transaminase (ALT), serum level of HCV RNA or alpha-fetoprotein (AFP) on the other. However, positive correlations were disclosed between proliferative activity of hepatocytes on one hand and patient's age, grading and staging on the other. Advanced hepatic fibrosis correlated also with serum levels of AFP. The studies were supplemented with data on subcellular localization of HCV proteins. Moreover, they indicated that in HCV infection grading and staging, proliferative activity of hepatocytes and serum AFP level represent more valuable indices of the disease progress than those provided by cellular expression of three potentially oncogenic HCV proteins in vivo

The differences in the relationship between diastolic dysfunction, selected biomarkers and collagen turn-over in heart failure patients with preserved and reduced ejection fraction

Background: The aim of the study was to assess the correlation of the selected biomarkers and collagen turn-over indices with advanced echocardiographic parameters among patients with preserved and reduced ejection fraction (EF). Methods: We included 62 patients with the symptomatic heart failure. The patients were divided in to two groups according to the evaluated ejection fraction (EF — Simpson method): heart failure with reduced ejection fraction (HFrEF) group — 30 patients with low EF — 35–50% (16 male, mean age 54.9 ± 12.6), heart failure with preserved ejection fraction (HFpEF) group — 32 patients with EF > 50% (16 male, mean age 62.3 ± 7.6). Clinical evaluation included 6-min walk test, biochemistry, procollagen type I N-terminal propeptide (PINP), procollagen type III N-terminal propetide (PIIINP), matrix metaloproteinase-2 (MMP2), ghrelin, and galectin-3 levels measurements. Echocardiographic examination was performed with analysis of diastolic function and global longitudinal strain (GLS). Results: The GLS in the HFrEF group was significantly lower than in the HFpEF group at the baseline (GLS: 9.56 vs. 16.03, p < 0.01). There was a strong negative correlation of the PIIINP and GLS in HFrEF group (r = –0.74, p = 0.005), but only a moderate negative correlation in HFpEF (r = –0.55, p = 0.02). In the HFrEF group, there was a moderate negative correlation between the baseline level of galectin-3 and GLS (r = –0.59, p = 0.03). The correlation of ghrelin and tissue inhibitor of matrix metalloproteinase-1 with EF in the HFrEF group was moderate and statistically significant (r = 0.62, p = 0.02 and r = –0.63, p = 0.02, respectively). Conclusions: Procollagen type III peptide has a strong negative correlation with left ventricular GLS. Galectin-3 relationship with strain may indicate novel pathophysiological pathways and requires further investigation.

Ostry zespół wieńcowy bez uniesienia odcinka ST u 78−letniej pacjentki z krytycznym zwężeniem proksymalnego odcinka prawej tętnicy wieńcowej i ze współistniejącą przewlekłą okluzją pnia lewej tętnicy wieńcowej

Total occlusion of the left main coronary artery is a rare finding at coronary angiography. When present, patients most often have extensive collateral circulation from the right coronary artery. The mainstay of treatment is surgical with coronary artery bypass grafting. We present a case of a 78 year-old woman admitted to our department with two days history of nonspecific, abdominal pain. Her coronarography revealed chronic total occlusion of left main with concomitant critical, proximal right coronary artery stenosis.Total occlusion of the left main coronary artery is a rare finding at coronary angiography. When present, patients most often have extensive collateral circulation from the right coronary artery. The mainstay of treatment is surgical with coronary artery bypass grafting. We present a case of a 78 year-old woman admitted to our department with two days history of nonspecific, abdominal pain. Her coronarography revealed chronic total occlusion of left main with concomitant critical, proximal right coronary artery stenosis

Ocena zaburzeń oddychania w czasie snu z wykorzystaniem rejestracji holterowskiej u pacjentów z tętniczym nadciśnieniem płucnym oraz nadciśnieniem płucnym wtórnym do dysfunkcji lewej komory serca

Introduction. Sleep-disordered breathing (SDB) affects approximately 2–12% of the general population and the prevalence among patients with heart failure due to left ventricular dysfunction (LV–HF) is even higher. SDB is an important determinant of worse clinical outcomes in such patients. In contrast, the prevalence of SDB in pulmonary arterial hypertension (PAH) and its implications remain unclear. The purpose of this study was to compare relations between estimated apnea-hypopnoea index (eAHI) and clinical parameters in patients with LV–HF and PAH, with particular attention to the consequences of SDB.Material and methods. Eighty-one patients were screened for SDB using commercial Holter electrographic monitoring software that allowed evaluation of eAHI. The study population consisted of 39 LV–HF patients and 42 PAH patients. Results. While similar N-terminal pro B-type natriuretic peptide (NT-proBNP) levels were noted in both groups, LV–HF patients were characterized by higher age (63 vs. 50 years, respectively, p < 0.001), higher proportion of males (87% vs. 40%, p < 0.0001), and higher eAHI (24 vs. 14, p < 0.001) and body mass index (BMI) (28 vs. 25 kg/m2, p < 0.001) values compared to the PAH group. The prevalence of SDB, defined as eAHI > 15, was 64% in the LV–HF group and 36% in the PAH group. Parameters of time domain heart rate variability (HRV) analysis were lower in PAH vs. LV–HF. Patients with LV–HF had more ventricular arrhythmias than patients with PAH. In the LV–HF group, eAHI correlated positively with NT-proBNP level, and negatively with left ventricular ejection fraction and the mean heart rate. The median eAHI was 18.7, and patients with eAHI above the median had more supraventricular arrhythmias. In the PAH group, a negative correlation between eAHI and age was found. In the subgroup with eAHI < 15, rMSSD values were higher and idiopathic PAH predominated. The median eAHI was 8.4, and patients with eAHI above the median were younger and had higher BMI values. Conclusions. Sleep-disordered breathing was more frequent and eAHI was higher in patients with LV–HF compared to those with PAH, although it was present in more than one third of patients in the latter group. Higher eAHI values indicated more severe hemodynamic dysfunction in patients with LV–HF. In the PAH group, higher eAHI was associated with clinical presentation at a younger age. Patients with PAH seem to have worse HRV parameters compared to patients with left ventricular dysfunction.Wstęp. Zaburzenia oddychania w czasie snu (SDB) dotyczą 2–12% ogólnej populacji; jeszcze wyższy odsetek obserwuje się wśród pacjentów z niewydolnością serca spowodowaną dysfunkcją lewej komory (LV–HF). Występowanie SDB w tętniczym nadciśnieniem płucnym (PAH) oraz jego implikacje kliniczne pozostają niejasne. Celem pracy było porównanie relacji między oszacowanym wskaźnikiem bezdechu sennego (eAHI) a parametrami klinicznymi pacjentów z LV–HF i PAH, z uwzględnieniem konsekwencji obecności bezdechu sennego.Materiał i metody. Do badania włączono 81 chorych, u których wykonano 24-godzinne monitorowanie elektrokardiograficzne metodą Holtera w celu obliczenia eAHI. Populację podzielono na dwie grupy — 39 chorych z LV–HF o etiologii wieńcowej oraz 42 chorych z PAH.Wyniki. W grupie LV–HF dominowali mężczyźni (87% v. 40% w grupie PAH; p < 0,0001), w starszym wieku (63 v. 50 lat w grupie PAH; p < 0,001), z wyższymi wartościami wskaźnika masy ciała (BMI) (28 v. 25 kg/m2; p < 0,001) oraz niższą frakcją wyrzutową lewej komory (LVEF) (33 v. 56%; p < 0,000001), choć grupy charakteryzowała podobna średnia wartość stężenia N-końcowego fragmenty propetydu natriuretycznego typu B (NT-proBNP). Zaburzenia oddychania w czasie snu, zdefiniowane jako eAHI ponad 15, stwierdzono u 64% chorych z LV–HF i u 36% pacjentów z PAH. Wyższe wartości eAHI występowały w grupie LV–HF (24 v. 14; p < 0,001). Pacjenci z LV–HF cechowali się obecnością licznych arytmii komorowych, a przy wartościach eAHI powyżej mediany (> 18,7) potwierdzono zwiększoną częstość występowania arytmii nadkomorowej. W PAH obserwowano istotnie obniżone parametry czasowej zmienności rytmu zatokowego (HRV). W grupie LV–HF wykazano korelację eAHI z wartościami NT-proBNP i odwrotną korelację z LVEF oraz średnią dobową częstotliwością pracy serca. Z kolei eAHI w grupie chorych z PAH nie korelowało z NT-proBNP ani LVEF, ale było odwrotnie proporcjonalne do wieku. Wśród chorych z PAH i wartościami eAHI poniżej 15 przeważali pacjenci z PAH o etiologii idiopatycznej, z wyższymi wartościami rMSSD. Pacjentów z PAH i wartościami eAHI powyżej mediany (> 8,4) charakteryzowały młodszy wiek oraz wyższe wartości BMI.Wnioski. Zaburzenia oddychania podczas snu u pacjentów z PAH nie były tak częste jak u chorych z LV–HF, ale dotyczyły więcej niż 1/3 populacji. Wyższe wartości eAHI u chorych z LV–HF wskazują na zaawansowaną dysfunkcję hemodynamiczną. U pacjentów z PAH obecność SDB wiąże się z zachorowaniem w młodszym wieku i wskazuje na istotną dysregulację w zakresie autonomicznej kontroli pracy serca