Valsartan in the treatment of primary hypertension : Polish multicenter, randomised studies

Wstęp Celem pracy jest ocena skuteczności hipotensyjnej i tolerancji walsartanu u pacjentów z łagodnym i umiarkowanym nadciśnieniem tętniczym pierwotnym. Metody Badaniami objęto 93 pacjentów (34K/60M), w wieku 18-80 lat (śr. 50 lat) z nadciśnieniem pierwotnym pochodzących z 6 ośrodków klinicznych w Polsce, u których przy końcu 2-tygodniowego stosowania placebo wartości ciśnienia rozkurczowego (DBP — diastolic blood pressure) mieściły się w granicach 95-115 mm Hg. Walsartan (Diovan®, Novartis) stosowano w jednorazowej dawce dobowej 80 mg przez 8 tygodni, z możliwością dodania hydrochlorotiazydu w dawce 12,5 mg/dobę po 4 tygodniach leczenia pacjentom, u których DBP nie spadło poniżej 95 mm Hg. Ciśnienie mierzono co 2 tygodnie metodą tradycyjną (standaryzowane manometry rtęciowe). Po okresie stosowania placebo (PA), po 4 i 8 tygodniach leczenia aktywnego u pacjentów wykonywano całodobową rejestrację ciśnienia tętniczego (ABPM) aparatem Spacelab 90121. Wyniki W dwóch 4-tygodniowych okresach badania uzyskano istotne statystycznie obniżenie ciśnienia tętniczego w porównaniu z okresem po PA. Ciśnienie skurczowe (SBP — systolic blood pressure) po 8 tygodniach leczenia obniżyło się ze 156 ± 14,8 mm Hg do 136 ± 15 mm Hg — mierzone metodą standardową oraz ze 144 ± 15,3 mm Hg do 134 ± 14,3 mm Hg — w rejestracji dobowej. Ciśnienie rozkurczowe obniżyło się odpowiednio z 103 ± 4,4 mm Hg do 89 ± 8,9 mm Hg — mierzone metodą standardową oraz z 98 ± 12,2 do 90 ± 12,9 mm Hg — w zapisie dobowym ABPM. U 61 osób poddanych monoterapii (Diovan®) po 8 tygodniach leczenia SBP średnio obniżyło się o 20 mm Hg, a DBP o 16 mm Hg — mierzone metodą standardową, a w zapisie dobowym ABPM odpowiednio o 9 i 8 mm Hg. U 32 pacjentów wymagających leczenia skojarzonego SBP po 8 tygodniach leczenia obniżyło się o 21 mm Hg, zaś DBP o 13 mm Hg — mierzone metodą standardową, a w zapisie dobowym odpowiednio o 12 i 9 mm Hg. Działania niepożądane w postaci bólów i zawrotów głowy, osłabienia i zgagi obserwowano u 6 pacjentów stosujących Diovan® i u 8 chorych leczonych metodą skojarzoną. Powyższe dolegliwości były umiarkowane i ustępowały w trakcie dalszego leczenia. Wnioski Walsartan jest skutecznym i dobrze tolerowanym lekiem hipotensyjnym zarówno w monoterapii, jak i w leczeniu skojarzonym z hydrochlorotiazydem.Background The aim of the study was the evaluation of valsartan’s efficacy and tolerance in patients with mild and moderate essential hypertension. Material and Methods The research carried out in six medical centres in Poland included 93 patients (60 male, 34 female), aged 18–80 (mean age: 50), with primary hypertension, whose diastolic blood pressure (DBP) at the end of a two-week placebo treatment ranged 95–115 mm Hg. Valsartan (Diovan®, Novartis) was administered as a single daily dose of 80 mg for 8 weeks. In case of patients whose DBP did not come down below 95 mm Hg after 4 weeks, a daily dose of 12,5 mg hydrochlorothiazide was added to the treatment. Blood pressure was measured with the traditional method (standardised mercurial manometers) every 2 weeks. After the period of placebo administration (PA), and after 4 and 8 weeks of treatment, 24-hour ambulatory blood pressure measurements (APBM) were performed with a Spacelab 90121 recorder. Results In both 4-week treatment periods, statistically significant reduction of blood pressure, as compared to the period of PA, was observed. After 8 weeks of treatment, systolic blood pressure (SBP) decreased from 156 ± ± 14,8 mm Hg to 136 ± 15 mm Hg (standard measurement), and from 144 ± 15,3 mm Hg to 134 ± 14,3 mm Hg (ABPM). DBP decreased respectively from 103 ± ± 4,4 mm Hg to 89 ± 8,9 mm Hg (standard method) and from 98 ± 12,2 to 90 ± 12,9 mm Hg in ABPM. After 8 weeks, in 61 patients who underwent only valsartan treatment, SBP decreased by 20 mm Hg on average, and DBP decreased by 16 mm Hg in standard method, and in ABPM by 9 and 8 mm Hg, respectively. After 8 weeks, in 32 patients who required combination treatment, SBP decreased by 21 mm Hg on average, and DBP decreased by 13 mm Hg in standard method, and in ABPM by 12 and 9 mm Hg, respectively. Side effects in form of headache, vertigo, general weakness and pyrosis were observed in 6 patients taking valsartan and in 8 in the combination treatment group. The side effects were moderate and withdrew as the treatment continued. Conclusion Valsartan is an effective and well tolerated antihypertensive drug, both when administered in monotherapy and in combination with hydrochlorothiazide

High soluble transferrin receptor in patients with heart failure:a measure of iron deficiency and a strong predictor of mortality

Background: Iron deficiency (ID) is frequent in heart failure (HF), linked with exercise intolerance and poor prognosis. Intravenous iron repletion improves clinical status in HF patients with LVEF≤45%. However, uncertainty exists about the accuracy of serum biomarkers in diagnosing ID. Study Aims: 1) to identify the iron biomarker with the greatest accuracy for the diagnosis of ID in bone marrow in patients with ischaemic HF; 2) to establish the prevalence of ID using this biomarker and its prognostic value in HF patients. Methods and Results: Bone marrow was stained for iron in 30 patients with ischaemic HF with LVEF≤45% and 10 healthy controls, and ID was diagnosed for 0‐1 grades (Gale scale). 791 patients with HF with LVEF≤45% were prospectively followed‐up for 3 years. Serum ferritin, transferrin saturation, soluble transferrin receptor (sTfR) were assessed as iron biomarkers. Most patients with HF (25, 83%) had ID in bone marrow, but none of the controls (p<0.001). Serum sTfR had the best accuracy in predicting ID in bone marrow (AUC: 0.920, 95%CI: 0.761‐0.987, for cut‐off 1.25 mg/L sensitivity 84%, specificity 100%). Serum sTfR was ≥1.25 mg/L in 47% of HF patients, in 56% and 46% of anaemics and non‐anaemics, respectively (p<0.05). The reclassification methods revealed that serum sTfR significantly added the prognostic value to the baseline prognostic model, and to the greater extent than plasma NT‐proBNP. Based on internal derivation and validation procedures, serum sTfR ≥1.41 mg/L was the optimal threshold for predicting 3‐year mortality, independent of other established variables. Conclusions: High serum sTfR accurately reflects depleted iron stores in bone marrow in patients with HF, and identifies those with a high 3‐year mortality

Management of valvular heart disease in patients with cancer: Multidisciplinary team, cancer-therapy related cardiotoxicity, diagnosis, transcatheter intervention, and cardiac surgery. Expert opinion of the Association on Valvular Heart Disease, Association of Cardiovascular Interventions, and Working Group on Cardiac Surgery of the Polish Cardiac Society

The Association on Valvular Heart Disease, Association of Cardiovascular Interventions, and the Working Group on CardiacSurgery of the Polish Cardiac Society have released a position statement on risk factors, diagnosis, and management of patients with cancer and valvular heart disease (VHD). VHD can occur in patients with cancer in several ways, for example, it can exist or be diagnosed before cancer treatment, after cancer treatment, be an incidental finding during imaging tests, endocarditis related to immunosuppression, prolonged intravenous catheter use, or combination treatment, and nonbacterial thrombotic endocarditis. It is recommended to employ close cardiac surveillance for patients at high risk of complications during and after cancer treatment and for cancer treatments that may be cardiotoxic to be discussed by a multidisciplinary team. Patients with cancer and pre-existing severe VHD should be managed according to the 2021 European Society of Cardiology (ESC) and European Association for Cardio-Thoracic Surgery (EACTS) guidelines for VHD management, taking into consideration cancer prognosis and patient preferences

Using the Hotspot function of the Xerte tool for developing interactive presentations

Due to dynamic development of e-learning tools, which are available on the commercial and non-commercial market, e-learning is today a common and valued form of supporting the learning process. To achieve some cognitive objectives, for example to visualize the structures or patterns, it is very effective to use techniques like interactive presentations. A particularly useful function of the presentation enforcing student's interest is the Hot Spot. This activity is available within a non-commercial tool environment - Xerte. The present publication focuses on the benefits and educational opportunities of this environment. In particular, the authors share their experiences of the Hot Spot activity creation in three different variants. The publication describes, in a comprehensive and detailed way, the creation of Hotspots, saving presentations in SCORM format as well publishing presentations on e-learning platform Moodle

Valsartan in the Treatment of Primary Hypertension — Polish Multicenter, Randomised Study

Wstęp Celem pracy jest ocena skuteczności hipotensyjnej i tolerancji walsartanu u pacjentów z łagodnym i umiarkowanym nadciśnieniem tętniczym pierwotnym. Metody Badaniami objęto 93 pacjentów (34K/60M), w wieku 18–80 lat (śr. 50 lat) z nadciśnieniem pierwotnym pochodzących z 6 ośrodków klinicznych w Polsce, u których przy końcu 2-tygodniowego stosowania placebo wartości ciśnienia rozkurczowego (DBP — diastolic blood pressure) mieściły się w granicach 95–115 mm Hg. Walsartan (Diovan®, Novartis) stosowano w jednorazowej dawce dobowej 80 mg przez 8 tygodni, z możliwością dodania hydrochlorotiazydu w dawce 12,5 mg/ /dobę po 4 tygodniach leczenia pacjentom, u których DBP nie spadło poniżej 95 mm Hg. Ciśnienie mierzono co 2 tygodnie metodą tradycyjną (standaryzowane manometry rtęciowe). Po okresie stosowania placebo (PA), po 4 i 8 tygodniach leczenia aktywnego u pacjentów wykonywano całodobową rejestrację ciśnienia tętniczego (ABPM) aparatem Spacelab 90121. Wyniki W dwóch 4-tygodniowych okresach badania uzyskano istotne statystycznie obniżenie ciśnienia tętniczego w porównaniu z okresem po PA. Ciśnienie skurczowe (SBP — systolic blood pressure) po 8 tygodniach leczenia obniżyło się ze 156 ± 14,8 mm Hg do 136 ± 15 mm Hg — mierzone metodą standardową oraz ze 144 ± 15,3 mm Hg do 134 ± 14,3 mm Hg — w rejestracji dobowej. Ciśnienie rozkurczowe obniżyło się odpowiednio z 103 ± 4,4 mm Hg do 89 ± ± 8,9 mm Hg — mierzone metodą standardową oraz z 98 ± 12,2 do 90 ± 12,9 mm Hg — w zapisie dobowym ABPM. U 61 osób poddanych monoterapii (Diovan®) po 8 tygodniach leczenia SBP średnio obniżyło się o 20 mm Hg, a DBP o 16 mm Hg — mierzone metodą standardową, a w zapisie dobowym ABPM odpowiednio o 9 i 8 mm Hg. U 32 pacjentów wymagających leczenia skojarzonego SBP po 8 tygodniach leczenia obniżyło się o 21 mm Hg, zaś DBP o 13 mm Hg — mierzone metodą standardową, a w zapisie dobowym odpowiednio o 12 i 9 mm Hg. Działania niepożądane w postaci bólów i zawrotów głowy, osłabienia i zgagi obserwowano u 6 pacjentów stosujących Diovan® i u 8 chorych leczonych metodą skojarzoną. Powyższe dolegliwości były umiarkowane i ustępowały w trakcie dalszego leczenia. Wnioski Walsartan jest skutecznym i dobrze tolerowanym lekiem hipotensyjnym zarówno w monoterapii, jak i w leczeniu skojarzonym z hydrochlorotiazydemBackground The aim of the study was the evaluation of valsartan’s efficacy and tolerance in patients with mild and moderate essential hypertension. Material and Methods The research carried out in six medical centres in Poland included 93 patients (60 male, 34 female), aged 18–80 (mean age: 50), with primary hypertension, whose diastolic blood pressure (DBP) at the end of a two-week placebo treatment ranged 95–115 mm Hg. Valsartan (Diovan®, Novartis) was administered as a single daily dose of 80 mg for 8 weeks. In case of patients whose DBP did not come down below 95 mm Hg after 4 weeks, a daily dose of 12,5 mg hydrochlorothiazide was added to the treatment. Blood pressure was measured with the traditional method (standardised mercurial manometers) every 2 weeks. After the period of placebo administration (PA), and after 4 and 8 weeks of treatment, 24-hour ambulatory blood pressure measurements (APBM) were performed with a Spacelab 90121 recorder. Results In both 4-week treatment periods, statistically significant reduction of blood pressure, as compared to the period of PA, was observed. After 8 weeks of treatment, systolic blood pressure (SBP) decreased from 156 ± ± 14,8 mm Hg to 136 ± 15 mm Hg (standard measurement), and from 144 ± 15,3 mm Hg to 134 ± 14,3 mm Hg (ABPM). DBP decreased respectively from 103 ± ± 4,4 mm Hg to 89 ± 8,9 mm Hg (standard method) and from 98 ± 12,2 to 90 ± 12,9 mm Hg in ABPM. After 8 weeks, in 61 patients who underwent only valsartan treatment, SBP decreased by 20 mm Hg on average, and DBP decreased by 16 mm Hg in standard method, and in ABPM by 9 and 8 mm Hg, respectively. After 8 weeks, in 32 patients who required combination treatment, SBP decreased by 21 mm Hg on average, and DBP decreased by 13 mm Hg in standard method, and in ABPM by 12 and 9 mm Hg, respectively. Side effects in form of headache, vertigo, general weakness and pyrosis were observed in 6 patients taking valsartan and in 8 in the combination treatment group. The side effects were moderate and withdrew as the treatment continued. Conclusion Valsartan is an effective and well tolerated antihypertensive drug, both when administered in monotherapy and in combination with hydrochlorothiazide

Significance of Urban Vegetation on Lawns Regarding the Risk of Fire

Urban green infrastructure significantly influences the functioning of a city and the comfort of its residents. Lawns are an essential element of public greenery. They represent a live component, and if they are lacking, of low quality, or neglected, this will cause major problems in the urban environment. The vegetation structure of urban grassy areas changes under the influence of different management methods used for their maintenance. The main goal of this study was to evaluate the species diversity of urban lawns and to determine the influence of this vegetation on factors based on the representation of the species found. Three sites with urban lawns were chosen in a built-up city area where different types of vegetation management were applied: Typical management, in which grassy areas are mowed twice a year; intensive management, in which lawns are mowed several times a year and the biomass is removed; and extensive management, in which lawns are mowed irregularly, once a year at most, and the biomass is left unevenly on the site. Extensive management and unkempt urban grassy areas represent a high risk of fire due to the presence of plant species that produce great amounts of biomass. Combined with dry and warm weather, the dead biomass can lead to outbreaks of fire. Extensive management of urban grassy areas brings some benefits, such as lower maintenance costs and increased biodiversity and bioretention. On the other hand, intensive management reduces the risk of fire and the biodiversity of the plant community. Attention should be paid to the composition of vegetative species and their functions that could threaten the safety of residents, with the risk of fire being one of them. However, the vegetation biomass of grassy areas affected by management practices is only a precondition for the risk of fire because weather and drought occurrence play important roles as well

Postępowanie w wadach zastawkowych serca u pacjentów z chorobą nowotworową: zespół interdyscyplinarny, kardiotoksyczność, diagnostyka, interwencje przezcewnikowe i chirurgiczne. Opinia ekspertów Asocjacji Wad Zastawkowych Serca PTK, Asocjacji Interwencji Sercowo-Naczyniowych PTK, Sekcji Kardiochirurgii PTK

Asocjacje Wad Zastawkowych Serca i Interwencji Sercowo-Naczyniowych oraz Grupa Robocza do spraw Kardiochirurgii Polskiego Towarzystwa Kardiologicznego wydały stanowisko dotyczące czynników ryzyka, diagnostyki i postępowania u pacjentów z chorobą nowotworową i zastawkową chorobą serca (VHD, valvular heart disease). Choroba zastawkowa serca może wystąpić u pacjentów z nowotworem w różnych sytuacjach, takich jak: istniejąca lub rozpoznana przed leczeniem nowotworu, po leczeniu nowotworu, przypadkowo stwierdzona w badaniach obrazowych, jako zapalenie wsierdzia związane z immunosupresją, długotrwałym stosowaniem cewników dożylnych lub leczeniem skojarzonym oraz niebakteryjne zapalenie wsierdzia. Zaleca się ścisły nadzór kardiologiczny u pacjentów z wysokim ryzykiem powikłań w trakcie i po leczeniu nowotworu oraz omówienie przez zespół interdyscyplinarny terapii potencjalnie kardiotoksycznego nowotworu. Pacjenci z chorobą nowotworową i istniejącą wcześniej ciężką VHD powinni być prowadzeni zgodnie z wytycznymi ESC/EACTS z 2021 roku dotyczącymi postępowania w VHD, z uwzględnieniem rokowania w chorobie nowotworowej i preferencji pacjenta

Preliminary Research on the Effect of Hyperbaric Oxygen Therapy in Patients with Post-COVID-19 Syndrome

Negative consequences and medical complications of COVID-19 can persist for up to several months after initial recovery. These consequences can include stroke, diabetes, decreased lung diffusing capacity, sleep apnea, pulmonary fibrosis, arrhythmia, myocarditis, fatigue, headaches, muscle aches, heart rate fluctuations, sleep problems, memory problems, nervousness, anxiety, and other neurological disorders. Thirty-one patients who reported symptoms related to previous COVID-19 disease of both sexes were enrolled in the initial program. The patients underwent compression sessions in a multiplace hyperbaric chamber. Each patient underwent a cycle of 15 compressions. Before the first session, each participant completed a venous blood gas test, a Fullerton test, and two spirometry tests (one before the Fullerton test and one after the test). Patients completed psychotechnical tests, a questionnaire on quality of life (Polish version of EQ-5D-5L), and a questionnaire on specific symptoms accompanying the disease and post-infection symptoms. The results showed significant improvements in areas such as quality of life, endurance and strength, some spirometric parameters, the anion gap and lactate levels, working memory, and attention in the group of treated patients. In contrast, there were no changes in pH, pO2, pCO2, glucose, and excess alkaline values. A follow-up interview confirmed that the beneficial effects were maintained over time. Considering the results obtained, including the apparent improvement in the patient’s clinical condition, it can be concluded that the use of 15 compression sessions was temporarily associated with a noticeable improvement in health and performance parameters as well as improvement in certain blood gas parameters

Polish Multicenter Registry (Pol-LAS-SE registry). Stress echocardiography in low-gradient aortic stenosis in Poland: numbers, settings, results, complications and clinical practice

Background: The diagnostic workup of low-gradient aortic stenosis (LG AS) is a challenge in clinical practice.Aims: Our goal was to assess the diagnostic value of stress echocardiography (SE) performed in patients with undefined LG AS with low and preserved ejection fraction (EF) and the impact of its result on therapeutic decisions in Polish third level of reference.Methods: All the patients with LG AS and with SE performed were recruited in 16 Polish cardiology departments between 2016 and 2019. The main exclusion criteria were as follows: moderate or severe aortic or mitral regurgitation and mitral stenosis.Results: The study group included 163 patients (52% males) with LG AS who underwent SE for adequate diagnostic and therapeutic decision. In 14 patients DSE was non-diagnostic. The mean aortic valve (AV) pressure gradient was 24.1 (7.3) mm Hg, while an AV area was 0.86 (0.2) cm2. Among 149 patients with conclusive DSE, severe AS was found in 59.8%, pseudo-severe in 22%, and moderate AS in 18%. There were no cases of death or vascular events related to DSE. Among 142 patients 63 (44%) patients had an aortic valve intervention in a follow-up (median: 208 days; lower-upper quartile: 73–531 days). Based on the result of the DSE test, severe AS was significantly more often associated with qualification to interventional treatment compared to the moderate and pseudo-severe subgroups (P <0.0001).Conclusions: The DSE test in severe AS is a valuable diagnostic tool in patients with LG AS in Poland