Cukrzyca jako czynnik ryzyka udaru niedokrwiennego mózgu

Background. Diabetes mellitus and stroke is a disease with a high prevalence and high rates of mortality.Aim. Aim of this study is to analyze the risk factors of ischemic stroke in patients with diabetes and non-diabetic ones and glucose concentrations to determine the effect on the prognosis in these patients.Material and methods. The study included 299 people with a history of ischemic stroke, including 21.5% of diagnosed and treated diabetes and 78.5% without diagnosed diabetes who were hospitalized in 2010 in the Department of Neurology, University Hospital in Bialystok. Retrospective analysis of medical records.Results. Diabetes was present in 59.4% women and 21.4% of men (NS). The mean age of patients with diabetes and ischemic stroke was 74.62±11.89 years, and non-diabetic 73.56±10.13 years (NS). Hypertension was present among 80.4% of patients with ischemic stroke without diabetes and 92.2% with diabetes (p<0.001). Atrial fibrillation occurred in 40.4% of patients with ischemic stroke without diabetes and in 46.9% of ischemic stroke, and diabetes (NS). Triglycerides in patients with ischemic stroke and diabetes were on average 133.1±78.24 mg/dl and was significantly higher than in patients with ischemic stroke without diabetes (110.51±40.14 mg/dl) (p<0.05). HDL cholesterol in patients with ischemic stroke without diabetes were on average 44.10±13.66 mg/dl and was significantly higher than in patients with ischemic stroke, and diabetes (40.17±11.72 mg/dl) (p<0.05). Carotid stenosis was found in 14.9% of patients with ischemic stroke without diabetes and 29.7% of ischemic stroke, and diabetes (p<0.001). The mean concentration of glucose in patients with ischemic stroke and diabetes and circadian profile of fasting plasma glucose was 198.65±66.41 mg/dl and non-diabetic 164.70±77.84 mg/dl (p<0.005). Mean fasting glucose from the last measurement before discharge plasma glucose in patients with ischemic stroke, and diabetes was on average 158.16±40.26 mg/dl and non-diabetic 134.59±32.49 (p<0.001). Length of hospitalization of patients with ischemic stroke, and diabetes was on average 17.77±10.95 days and was significantly longer than patients with ischemic stroke without diabetes (15.05±11.54 days) (p<0.001). Death occurred in 9.4% of patients with ischemic stroke and diabetes, and 8.9% without diabetes (NS).Conclusions: 1. The most common risk factors in patients with ischemic stroke were hypertension, diabetes, atrial fibrillation. While patients with diabetes and ischemic stroke were hypertension, carotid stenosis and elevated triglycerides. 2. Plasma glucose at admission on the first and last measurement of fasting was significantly higher in patients with ischemic stroke and concomitant diabetes and in those who died. 3. The prognosis in patients with ischemic stroke, and diabetes was significantly worse (longer duration of hospitalization, a higher proportion of deaths) compared to patients without diabetes. (PNN 2012;1(4):136-143)Wprowadzenie. Cukrzyca i udar mózgu to schorzenia o znacznym stopniu rozpowszechnienia i wysokich wskaźnikach śmiertelności.Cel. Celem pracy jest analiza czynników ryzyka udaru niedokrwiennego mózgu u chorych z cukrzycą i bez współistniejącej cukrzycy oraz określenie wpływu stężenia glikemii na rokowanie w tych grupach pacjentów.Materiał i metody. Badaniami objęto 299 osób po przebytym udarze niedokrwiennym mózgu (unm), w tym 21,5% z rozpoznaną i leczoną cukrzycą oraz 78,5% bez rozpoznanej cukrzycy, hospitalizowanych w 2010 roku w Klinice Neurologii Uniwersyteckiego Szpitala Klinicznego w Białymstoku. Przeprowadzono retrospektywną analizę dokumentacji medycznej.Wyniki. Cukrzyca występowała u 59,4% kobiet i 21,4% mężczyzn (NS). Średni wiek pacjentów z cukrzycą i udarem niedokrwiennym mózgu wynosił 74,62±11,89 lat, a bez współistniejącej cukrzycy 73,56±10,13 lat (NS).Nadciśnienie tętnicze występowało wśród 80,4% pacjentów z unm bez cukrzycy i 92,2% ze współistniejącą cukrzycą (p<0,001). Migotanie przedsionków występowało u 40,4% chorych z unm bez cukrzycy i u 46,9% z unm i cukrzycą (NS). Stężenie triglicerydów wśród pacjentów z unm i cukrzycą wynosiło średnio 133,1±78,24 mg/dli było istotnie wyższe niż u pacjentów z unm bez cukrzycy (110,51±40,14 mg/dl) (p<0,05). Stężenie cholesterolu HDL u pacjentów z unm bez cukrzycy wynosiło średnio 44,10±13,66 mg/dl i było istotnie wyższe niż u pacjentów z unm i cukrzycą (40,17±11,72 mg/dl) (p<0,05). Zwężenie naczyń szyjnych stwierdzono u 14,9% pacjentów z unm bez cukrzycy oraz 29,7% z unm i cukrzycą (p<0,001). Średnie stężenie glukozy u pacjentów z unm i cukrzycą z I dobowego profilu glikemii na czczo wynosiło 198,65±66,41 mg/dl, a bez cukrzycy 164,70±77,84 mg/dl(p<0,05). Średnie stężenie glukozy na czczo z ostatniego pomiaru glikemii przed wypisem u pacjentów z unm i cukrzycą wynosiło średnio 158,16±40,26 mg/dl, a bez cukrzycy 134,59±32,49 (p<0,001). Czas hospitalizacji pacjentów z unm i cukrzycą wynosił średnio 17,77±10,95 dni i był istotnie dłuższy niż pacjentów z unm bez cukrzycy (15,05±11,54 dni) (p<0,001). Zgon wystąpił u 9,4% osób z unm i cukrzycą oraz 8,9% bez cukrzycy (NS).Wnioski. 1). Najczęściej występującymi czynnikami ryzyka u pacjentów z udarem niedokrwiennym mózgu były: nadciśnienie tętnicze, cukrzyca, migotanie przedsionków. Natomiast wśród pacjentów z cukrzycą i udarem niedokrwiennym mózgu były: nadciśnienie tętnicze, zwężenie naczyń szyjnych i podwyższone stężenie triglicerydów. 2). Stężenie glukozy przy przyjęciu przy pierwszym i ostatnim pomiarze na czczo było istotnie wyższe u pacjentów z udarem niedokrwiennym mózgu i współistniejącą cukrzycą oraz u osób, które zmarły. 3). Rokowanie u pacjentówz udarem niedokrwiennym mózgu i cukrzycą było istotnie gorsze (dłuższy okres hospitalizacji, większy odsetek zgonów) w porównaniu do osób bez cukrzycy. (PNN 2012;1(4):136-143

Wyniki leczenia wemurafenibem chorych na zaawansowanego czerniaka w ramach programu lekowego w Polsce

Introduction. Melanoma is a heterogeneous group of tumours with poor prognosis if the disease is metastatic. More than half of patients with melanoma of the skin have detectable mutations in the BRAF gene. Vemurafenib is the BRAF kinase inhibitor used in the treatment of patients with advanced melanoma with the BRAF mutation. This improves time to progression-free survival and overall survival in patients with this diagnosis. The aim of the study was to analyse the results of treatment and safety of vemurafenib in patients treated during the Polish drug programme. Materials and methods .Between October 2013 and April 2015 a total of 189 patients were treated, 90 women and 99 men, who had previously been diagnosed with unresectable/metastatic melanoma with BRAF V600 mutation. Patients received vemurafenib in 960 mg dose twice per day. The estimated progression-free survival, overall survival and adverse events were assessed. For the survival analysis the Kaplan-Meier method and log-rank test (log-rank) for multi-factor analysis were used. Results. In the first evaluation of the effectiveness of treatment, 8 patients (4.3%) had a complete response, 75 patients (39.7%) partial response, 62 patients (32.8%) had stable disease, and 44 patients (23.2%) had progression of the disease. The disease was controlled in 76.7% of patients. After progression during the therapy with vemurafenib 27% of the patients received subsequent lines of systemic therapy. Twenty-eight patients received chemotherapy and 22 patients immunotherapy with ipilimumab. During the last analysis dated 5 September 2015, the median observation time for still living patients was 8 months (range 3–26). Median progression-free survival was 6.7 months. The median overall survival was 12 months. 146 patients (77%) had adverse events, mostly in the form of dermal toxicity of Grades 1 and 2. Thirty-two patients (17%) presented with side effects of the 3rd and 4th grades of toxicity. Two patients had to stop the treatment due to the toxicity. There were no deaths reported due to the toxicity of treatment. Conclusions. The multicentre analysis confirmed the efficacy and safety of vemurafenib in routine clinical practice in a heterogeneous group of advanced melanomas with BRAF mutation. We confirmed the importance of the known prognostic factors for overall survival in this group of patients, such as lactate dehydogenaze activity (LDH) and ECOG performance status. The current survival of patients with the metastatic melanomas with BRAF mutations are longer than those observed in historical groups.  Wstęp. Czerniak należy do heterogennej grupy nowotworów o bardzo złym rokowaniu w przypadku rozsiewu choroby. U ponad połowy chorych na czerniaka skóry stwierdza się obecność mutacji w obrębie genu BRAF. Wemurafenib jest inhibitorem kinazy BRAF stosowanym w leczeniu chorych na zaawansowanego czerniaka z mutacją BRAF, który poprawia u nich czas przeżycia wolny od progresji choroby oraz przeżycia całkowitego. Celem pracy jest analiza wyników leczenia oraz bezpieczeństwa terapii wemurafenibem u chorych leczonych w ramach programu lekowego w Polsce. Materiały i metody. W okresie od października 2013 do kwietnia 2015 roku leczonych było 189 chorych (90 kobiet i 99 mężczyzn) z rozpoznaniem nieresekcyjnego/przerzutowego czerniaka z mutacją BRAF V600. Chorzy otrzymywali wemurafenib w dawce wyjściowej 960 mg dwa razy na dobę. Oceniano czas wolny od progresji choroby, czas przeżycia całkowitego oraz monitorowano działania niepożądane. Do analizy przeżycia użyto metody Kaplana-Meiera oraz testu logarytmicznego rang (log-rank) dla analiz dwuczynnikowych. Wyniki. W pierwszej ocenie skuteczności leczenia u 8 chorych (4,3%) stwierdzono całkowitą odpowiedź, u 75 chorych (39,7%) częściową odpowiedź, u 62 chorych (32,8%) stabilizację choroby, a u 44 chorych (23,2%) progresję choroby. Kontrolę choroby wykazano u 76,7% chorych. Po progresji w trakcie terapii wemurafenibem 27% chorych otrzymało kolejne linie leczenia systemowego — 28 chorych chemioterapię, 22 chorych ipilimumab. Podczas ostatniej analizy z dnia 5 września 2015 mediana czasu obserwacji dla żyjących chorych wyniosła 8 miesięcy (zakres 3–26). Mediana przeżycia wolnego od progresji wyniosła 6,7 miesiąca. Mediana czasu całkowitego przeżycia wyniosła 12 miesięcy. U 146 chorych (77%) stwierdzono działania niepożądane, głównie pod postacią toksyczności skórnej w stopniu 1. i 2., u 32 chorych (17%) objawy uboczne w 3.–4. stopniu toksyczności. U dwóch chorych zakończono leczenie z powodu toksyczności. Nie było zgonów spowodowanych toksycznością leczenia. Wnioski. Przeprowadzona analiza wieloośrodkowa potwierdziła skuteczność i bezpieczeństwo leczenia wemurafenibem w rutynowej praktyce klinicznej w heterogennej grupie zaawansowanych czerniaków z obecnością mutacji BRAF. Potwierdzono wagę znanych czynników prognostycznych dla całkowitego przeżycia w tej grupie chorych, takich jak aktywność dehydrogenazy mleczanowej (LDH) i wyjściowy stan sprawności wg ECOG. Obecne przeżycia chorych w grupie przerzutowych czerniaków z mutacją BRAF są dłuższe niż obserwowane w próbach historycznych.

Zalecenia Polskiej Grupy Mięsakowej w odniesieniu do postępowania diagnostyczno-terapeutycznego oraz kontroli u chorych na neurofibromatozę typu 1 (NF1) oraz związanego z nią złośliwego nowotworu osłonek nerwów obwodowych

Type 1 neurofibromatosis (NF1 syndrome in von Recklinghausen’s disease) is inherited as an autosomal dominant disease, caused by mutations in the NF1 gene encoding the neurofibromin protein. NF1 patients are at an increased risk of the develop­ment of a malignant neoplasm and their life span is shorter by 20 years than that of the general population. National Institute of Health (NIH) criteria make a diagnosis possible from about 4 years of age. Examination of children and adults should encom­pass a physical and a subjective component, but also next-generation sequencing (NGS) genetic analysis, histopathological examination of skin lesions, neurological, ophthalmological and radiological examination. If a malignant peripheral nerve sheath tumor (MNPST) is diagnosed in a patient with NF1, the therapeutic procedure should not differ from the general principles of treating soft tissue sarcomas. Patients from the high risk group should be monitored at least once a year, the remaining patients once every 2–3 years by a specialized medical team, and every year by their primary physicians, internal medicine specialists and dermatologists. Patients should have access to genetic counselling.Neurofibromatoza typu 1 (zespół NF1 w chorobie Recklinghausena, nerwiakowłókniakowatość typu 1), jest dziedziczona au­tosomalnie dominująco, a odpowiadają za nią mutacje genu NF1 kodującego białko neurofibrominy. Pacjenci z NF1 są naraże­ni na zwiększone ryzyko rozwoju nowotworu złośliwego i żyją około 20 lat krócej niż populacja ogólna. Kryteria National Insti­tute of Health (NIH) umożliwiają postawienie diagnozy już około 4 roku życia. Badanie dzieci i dorosłych powinno objąć bada­nie przedmiotowe i podmiotowe, ale też badanie genetyczne techniką sekwencjonowania nowej generacji (NGS), badanie histopatologiczne zmian skóry, badanie neurologiczne, okulistyczne i radiologiczne. W przypadku postawienia roz­poznania złośliwego nowotworu osłonek nerwów obwodowych (malignant peripheral nerve sheath tumor – MPNST) u chorego na NF1 postępowanie terapeutyczne nie powinno odbiegać od ogólnych zasad leczenia mięsaków tkanek miękkich. Pacjenci z grupy wysokiego ryzyka powinni być monitorowani przynajmniej raz w roku, pozostali – raz na 2–3 lata – przez zespół lekarzy specjalistów, a co roku przez lekarzy podstawowej opieki zdrowotnej (POZ), chorób wewnętrznych i dermatologów. Pacjentom należy zapewnić poradnictwo genetyczne

Increased Physical Activity at School Benefits Arterial Blood Pressure in Children—A Prospective Follow-Up Cohort Study

(1) Background: A sedentary lifestyle and low physical activity (PA) increase the risk of hypertension in children. The aim of this study was to assess the impact of increased PA at school by elevation of the number of compulsory physical education (PE) lessons on arterial blood pressure in children during a two-year follow-up. (2) Methods: Children (n = 245) born in 2007 attending a standard or elevated number of PE lessons in the school timetable (4 and 10 h a week, respectively) took part in the study. Blood pressure was measured starting from age approx. 10 to 12. (3) Results: Starting from a similar level, after 2 years, the percentage of children with normal blood pressure decreased in the standard-PE children from 83.25% to 78.03% but increased in the elevated-PE ones from 83.15% to 86.13%. The prevalence of both prehypertension and hypertension increased by one-third in the standard-PE children from 16.74% to 21.97% but decreased by one-sixth in the elevated-PE ones from 16.85% to 13.87%. The prevalence of hypertension itself increased by one-third in the standard-PE children from 9.82% to 13.12% but decreased in the elevated-PE ones by one-fifth from 9.60% to 7.75% (4) Conclusions: An increase in PA at school by the elevation of the number of PE lessons benefits children’s arterial blood pressure. Early prevention of hypertension in children can be supported by an adequate number of PE lessons in the school timetable

Increasing Physical Activity at School Improves Physical Fitness of Early Adolescents

(1) Introduction: Regular physical activity (PA) is an important part of a healthy lifestyle for children and adolescents. The aim of this study was to assess the impact of an increase in organized PA at school on the physical fitness (PF) of early adolescent boys and girls. (2) Methods: A total of 294 children born in 2007 took part in the study. The sample was divided into two groups: of increased PA at school (n = 140, girls n = 66, boys n = 74) and standard PA (n = 154, girls G n = 70, boys n = 84). Increased and standard PA levels consisted of 10 and 4 h of physical education lessons (PE) per week, respectively. PE consisted of team games and fitness exercises. Three of the Eurofit tests, core strength, long jump, and running speed, were used to measure PF. Tests were conducted in May 2018 and 2019, at an average age of a participant of 11 and 12 years, respectively. Descriptive statistics and cluster analysis were applied for analyzing the results. (3) Results: After one year of observation PF of children was improved in both groups (p < 0.001). However, it was greater in the increased PA group than in the standard one. A higher percentage of very good scores and lower of poor and very poor were noted in the increased PA group than the standard one (20.36% vs. 12.90%, p = 0.003 and 18.58% vs. 24.85%, p = 0.022, respectively). Boys obtained better results than girls (p = 0.003). Children achieved the best results in the shuttle run test, and the worst in the core strength. Children with normal body mass obtained better results than those with excessive ones. (4) Conclusions: Increasing the number of PE at school beneficially affects the fitness performance of early adolescents. To improve the health status of adolescents it is advisable to increase the number of compulsory PE lessons in the school curriculum

Eating Behaviour and Physical Fitness in 10-Year-Old Children Attending General Education and Sports Classes

The aim of this study was to evaluate the body mass index (BMI), selected eating behaviour and physical fitness of children aged 10 years attending general education and sports classes in Siedlce. Subject children were 272 girls and boys mean aged 10.8-years attending general education (GC) and sports classes (SC). Survey questionnaires consisted of 18 questions about eating behaviour and physical activity. The BMI was determined for each child and compared with reference percentile charts. Eurofit testing was used to measure physical fitness. Increased physical fitness was positively correlated with beneficial eating behaviour among children. SC children showed significantly more frequent dietary intakes of milk, dairy products, poultry, fish, wholegrain bread, groats and vegetables when compared to GC ones. However, significantly more GC children ate red meat more frequently along with snacking on confectionery and savouries than SC ones. Most subjects fell within correct BMI percentile ranges. Underweight was more frequent in SC children at 12.85% than in GC children 9.88%. Overweight and obesity was most often observed in GC children (respectively 19.73% and 5.51%) compared to SC ones (respectively 14.37% and 3.8%). SC children achieved significantly better results in the Eurofit tests. The highest levels of physical fitness and most favourable BMIs and eating behaviour were observed more often among SC children than GC ones. The results confirmed the beneficial health effects of physical fitness for children

Effects of Oxytetracycline and Gentamicin Therapeutic Doses on Hematological, Biochemical and Hematopoietic Parameters in Cyprinus carpio Juveniles

Hematological, biochemical and hematopoietic effects of therapeutic doses of two antibiotics, oxytetracycline (OTC) and gentamicin (GEN), in clinically healthy common carp juveniles were studied. The fish were divided into four groups: controls 1 and 2 (untreated or injected with 0.6% NaCl solution), and two groups treated with antibiotics (orally with 75 mg/kg OTC four times every two days or injected with a single dose (4 mg/kg) of GEN dissolved in 0.6% NaCl). Blood and head kidneys were sampled from all fish 3 days post-treatments for hematological, biochemical and hematopoietic tissue analyses. No major alterations in the values of hematological and serum biochemical parameters occurred following administration of OTC or GEN. Glucose concentrations were significantly lower in both groups of fish subjected to injections (Control 2 and GEN), while the oxidative metabolic activity of phagocytes increased in the antibiotic-treated groups (significantly in OTC). More alterations were observed in hematopoietic tissue. Immunocytochemical analysis revealed that G caused a significant increase in the rate of cell proliferation (PCNA-positive cells) and an increase in the frequency of apoptotic cells (caspase-positive). The frequency of lymphoid lineage decreased, which was related to a decrease in the abundance of mature lymphocytes in GEN-treated fish. Percentages of neutrophilic lineage were significantly elevated in OTC and GEN groups compared to controls. The obtained results showed no considerable hematotoxicity or hepatotoxicity of therapeutic doses of OTC and GEN to carp

Food Safety When Eating Out—Perspectives of Young Adult Consumers in Poland and Turkey—A Pilot Study

Food safety is perceived differently by consumers in different countries. The objective of this study was to examine the experience of young adults regarding the safety of meals eaten outside the home in Poland and Turkey. Questionnaire surveys were conducted on a group of 400 young adults. The findings provided new insights into cross-cultural consumer perceptions of the food safety of meals eaten out. Differences in the perception of the safety of the meals eaten out concerned both the manner in which consumers chose an eating establishment, the frequency with which they ate out, their experience of the meals consumed, and their practice of lodging complaints. Consumers in Poland and Turkey experienced different problems with the health quality of meals eaten out. The experience of consumers in Turkey reflected the occurrence of numerous cases of meals of poor quality, while in Poland it was smaller. This suggests that meals eaten out in Poland (an EU country) may have a lower health risk than in Turkey (a non-EU country). The method described in this study could be an additional tool for checking the operation of food safety systems in eating out establishments