Ocena przyczyn zgonów u chorych na przewlekłą obturacyjną chorobę płuc w podstawowej opiece zdrowotnej w okresie sześcioletniej obserwacji

Introduction: COPD is one of the most frequent respiratory diseases responsible for patients’ disability and mortality. In 2005 a single primary care practice, COPD was diagnosed in 183 out of 1,960 eligible subjects ≥ 40 years (9.3%). The aim of this study was to assess mortality rate and causes of deaths in this group after 6 years. Material and methods: In 2011 we invited all 183 patients with COPD recognised in 2005. We performed spirometry, physical examination, questionnaire of respiratory symptoms, smoking habits, concomitant diseases and treatment. Information about deaths was taken from primary care register, furthermore, family members were asked to deliver medical documentation or death certificate. Results: In 2011 we studied only 74 subjects (40.4%), 43 subjects died (23.5%) and 66 subjects were lost from the follow-up (36.1%). Cardiovascular diseases were the most frequent causes of deaths — 21 subjects (48.8%) (heart attack – 8 patients and stroke – 8 patients). Respiratory failure in the course of COPD exacerbation was the cause of 10 deaths (23.3%). Neoplastic diseases lead to 9 deaths (20.9%) (lung cancer 7 patients). Renal insufficiency was responsible for one death (2.325%), and the causes of 2 deaths remained unknown (4.65%). Subjects who died (predominantly males) were older, had higher MRC score and lower FEV1. Conclusions: Study performed six years after COPD diagnosis revealed that 23.5% of subjects died. The main causes of deaths were the following: cardiovascular diseases (mainly heart attack and stroke), COPD exacerbations and lung cancer (more than 75%). Death risk in COPD patients was associated with age, male sex, dyspnoea and severity of the disease.Wstęp: POChP jest jedną z najczęstszych chorób układu oddechowego, która prowadzi do inwalidztwa oddechowego oraz przedwczesnej śmierci. W 2005 roku w pojedynczej placówce podstawowej opieki zdrowotnej rozpoznano POChP u 183 spośród zbadanych 1960 osób, które ukończyły 40. rok życia (9,3%). Celem pracy była analiza częstości zgonów i ich przyczyn w grupie chorych na POChP po 6 latach obserwacji. Materiał i metody: W 2011 roku na badania kontrolne zaproszono wszystkie 183 osoby, u których rozpoznano POChP w 2005 roku. Badani wypełniali kwestionariusz dotyczący dolegliwości oddechowych, palenia tytoniu, chorób współistniejących oraz aktualnego leczenia. Po weryfikacji kwestionariusza wykonywano badanie przedmiotowe i spirometrię. Informację o śmierci pacjentów uzyskiwano z aktualnej kartoteki POZ oraz od rodzin badanych (na podstawie uzyskanej dokumentacji medycznej — ustalano datę i miejsce zgonu oraz jego przyczyny). Wyniki: W 2011 roku zbadano tylko 74 chorych (40,4%), 43 chorych zmarło (23,5%). Pozostałych 66 chorych nie udało się zbadać ponownie (36,1%). Choroby układu krążenia były najczęstszymi przyczynami zgonów u chorych na POChP — 21 chorych (48,8%) (w tym zawał serca — 8 chorych i udar mózgu — 8 chorych). Niewydolność oddychania w przebiegu POChP była przyczyną śmierci u 10 badanych (23,3%). Choroby nowotworowe były odpowiedzialne za 9 zgonów (20,9%) (rak płuc — 7 chorych). Pozostałe zgony wiązały się z niewydolnością nerek (1 chory; 2,325%) oraz przyczynami nieustalonymi (2 chorych; 4,65%). Chorzy na POChP, którzy zmarli (większość stanowili mężczyźni) byli starsi, mieli większe nasilenie duszności w skali MRC oraz niższe FEV1. Wnioski: Badania kontrolne wykonane po 6 latach od rozpoznania choroby ujawniły wysoką umieralność w badanej grupie (zmarło 43 chorych — 23,5%). Ponad 75% wszystkich zgonów było spowodowane chorobami układu krążenia (najczęściej zawałem serca i udarem mózgu), zaostrzeniami POChP i rakiem płuc. Czynnikami, które wpływały na wzrost ryzyka zgonu w badanej grupie, były: wiek, płeć męska, większe nasilenie duszności oraz cięższą postać choroby

Determination of neuron-specific enolase in patients with midgut-type tumour treated with somatostatin analogues

Introduction: The biochemical diagnosis of neuroendocrine tumours (NETs) uses assays of specific and nonspecific markers. Nonspecific markers include, among others, neuron-specific enolase (NSE). The aim of this study was to evaluate NSE in patients with midgut type tumours treated with somatostatin analogues. Material and methods: The study group of patients with NETs of the small intestine included 41 patients. Grade G1 was found in 19 cases, while G2 was seen in the remaining 22 cases. Liver metastases were found in all patients studied. The examined group of patients was treated with somatostatin analogues receiving octreotide LAR at a dose of 30 mg. The control of biochemical parameters was performed every 3 months and imaging examinations every 6 months. The Immuno-Biological Laboratories kit was used for determination of NSE concentration, where reference values were 12.5–25 ng/mL. Results: In the G1 group of patients, the median value of NSE concentration was 134.67 ng/mL, while in the G2 group, the value was 234.55 ng/mL and was significantly higher than in the G1 group (p = 0.003). In the determination of NSE concentration values according to the degree of liver involvement, in the group of patients with 10% liver involvement, the median value of NSE concentration was 143.21 ng/mL, while in the group with 25% liver involvement, the value was 251.82 ng/mL (p < 0.001). In the analysis of NSE concentration assessment in patients with disease progression, the median value was 234.65 ng/mL compared to the group with disease stabilization, where the median NSE value was significantly lower and amounted to 136.27 ng/mL (p < 0.001). Conclusions: In our study, we observed that NSE concentration values were significantly higher among patients with NET midgut type tumour with histological grade G2 and in patients with 25% liver involvement and progression of the disease process

Rola edukacji zdrowotnej u chorych z niewydolnością serca

According to European Society of Cardiology guidelines, the goal of heart failure (HF) management is to provide an effective system of care through the whole patient’s journey including hospital and ambulatory pathway. Strategies based on patients’ education, psychosocial support and monitoring should be considered as a fundamental part of multidisciplinary disease management programs and may lead to a reduction in mortality and morbidity and improvement in the quality of life. In this article, we focus on patient’s education strategies by describing different models: “one-to-one” strategies, multidisciplinary care management programs, activation of the family members, pharmaceutical care, and end-stage HF advance care planning. Furthermore, we explain the problem of health literacy among HF patients and describe actionable advice on how medical professionals can effectively improve patients’ comprehension and knowledge on disease management and the ability for self-care. Lastly, we review the latest evidence on outcomes obtained by HF education.Według wytycznych Europejskiego Towarzystwa Kardiologicznego głównym celem postępowania u chorych z niewydolnością serca jest tworzenie efektywnych systemów opieki na każdym etapie ścieżki pacjenta, włączając w to opiekę szpitalną i ambulatoryjną. Strategie postępowania oparte na edukacji, wsparciu psychologicznym i monitoringu powinny stanowić fundamentalny element wielospecjalistycznych zespołów zajmujących się prowadzeniem chorych z niewydolnością serca (HF). W niniejszym artykule autorzy skupiają się na edukacji pacjentów, przedstawiając różne jej modele: edukację w modelu rozmowy bezpośredniej, wielospecjalistyczne programy opieki, aktywację członków rodziny chorego, edukację z zaangażowaniem farmaceutów, a także edukację związaną z planowaniem opieki terminalnej. Ponadto opisano zagadnienie alfabetyzmu zdrowotnego wśród chorych z HF oraz zaproponowano możliwe działania, dzięki którym pracownicy ochrony zdrowia mogą poprawić zrozumienie informacji na temat choroby oraz zdolność do samoopieki wśród pacjentów. Autorzy przeprowadzili również przegląd dostępnych danych z piśmiennictwa na temat skuteczności edukacji w HF

Cerebral stroke - preclinical diagnosis and in conditions of the hospital accident ward

AdmissionThe cerebral stroke is a direct distress of the health and the life. The patient with the suspicion of stroke requires urgent intervention irrespective of the course of manifestations and their degree of the intensity. During the help at the preclinical stage an evaluation of practical parameters and registering direction and dynamics of changes are most important in this respect. As part of dealing on the Hospital accident ward with the sick person with the stated cerebral stroke one should verify and implement changes in applied curing by team members medical lifeguards.Purpose of researchAnalysis of diagnostic and therapeutic standards is a purpose of the work applied with patients with the cerebral stroke at the preclinical stage and as part of the care on the Hospital accident ward. Materials and methodsInformation taken from medical documentation of course of the process of diagnostics and curing 130 patients with the diagnosed cerebral stroke at medical institutions in the province constitutes research material Lublin. Analysis of medical documentation covered years 2013 up to 2016.DiscussionThe most frequent object manifestations stated at patients from the examined group: giddiness, headache, disequilibrium, nausea and/or the vomiting, the dysphagia, visual disturbances, pareses and hypoesthesias. According to analysis results and with literature at sick persons with the cerebral stroke a computed axial tomography and a magnetic resonance, as well as additional examinations are made examinations leading the way.ConclusionsAccording to the analysis of the results amongst early complications they observed: cerebral oedema, widen/ing moving the arrangement of the cellular brain, the secondary ischaemia of the haemorrhagic stroke. All described disorders of the awareness were diagnosed in the early phase of the cerebral stroke i.e. 4-5 hours from the beginning of the riot of any neurological warning signals

NT-proBNP as a neuroendocrine tumor biomarker: beyond heart failure

Introduction: Neuroendocrine tumors (NETs) are rare neoplasms that occur in various locations throughout the body. Despite their usually benign character, they might manifest with distant metastases. N-terminal prohormone of brain natriuretic peptide (NT-proBNP) has previously been described as a useful biomarker in diagnosing carcinoid heart disease (CHD), a common advanced NETs manifestation. We observed plasma concentrations of NT-proBNP in metastatic midgut NETs over a 4-year period. Objectives: We aimed to explore NT-proBNP concentrations in states of varying levels of cell proliferation and disease status. Our goal was to investigate NT-proBNP’s role in predicting disease progression in relation to previous research and up-to-date scientific guidelines. Patients and methods: We performed a retrospective multivariate analysis of NT-proBNP concentrations in 41 midgut NETs patients treated with somatostatin analogs, all with liver metastases. NT-proBNP concentrations were measured in every patient across 16 evenly distanced time points over a 48-month period and were compared to variables such as sex, age, grading, Ki-67, primary tumor location, and C T findings. Results: NT-proBNP concentrations correlated positively with higher liver tumor burden, higher grading, high Ki-67 levels, and with progressive disease in CT. There were no differences in NT-proBNP levels with regard to primary location (ileum vs jejunum), sex, and age. Conclusion: We conclude that NT-proBNP is a useful analyte for monitoring NETs progression, due to its increased concentration in scenarios implying increased cellular proliferation. These long-term follow-up results align with pre vious findings and suggest an additional role for NT-proBNP in diagnostic algorithms, beyond a CHD biomarker

High-throughput sequencing of gastric cancer patients : unravelling genetic predispositions towards an early-onset subtype

Background: Gastric cancer is the fourth most common cause of cancer-related death. Currently, it is broadly accepted that the molecular complexity and heterogeneity of gastric cancer, both inter- and intra-tumor, display important barriers for finding specific biomarkers for the early detection and diagnosis of this malignancy. Early-onset gastric cancer is not as prevalent as conventional gastric carcinoma, but it is a preferable model for studying the genetic background, as young patients are less exposed to environmental factors, which influence cancer development. Aim: The main objective of this study was to reveal age-dependent genotypic characteristics of gastric cancer subtypes, as well as conduct mutation profiling for the most frequent alterations in gastric cancer development, using targeted next-generation sequencing technology. Patients and methods: The study group included 53 patients, consisting of 18 patients with conventional gastric cancer and 35 with an early-onset subtype. The DNA of all index cases was used for next-generation sequencing, employing a panel of 94 genes and 284 single nucleotide polymorphisms (SNPs) (TruSight Cancer Panel, Illumina), which is characteristic for common and rare types of cancer. Results: From among the 53 samples processed for sequencing, we were able to identify seven candidate genes (STK11, RET, FANCM, SLX4, WRN, MEN1, and KIT) and nine variants among them: one splice_acceptor, four synonymous, and four missense variants. These were selected for the age-dependent differentiation of gastric cancer subtypes. We found four variants with C-Score ≥ 10, as 10% of the most deleterious substitutions: rs1800862 (RET), rs10138997 (FANCM), rs2230009 (WRN), and rs2959656 (MEN1). We identified 36 different variants, among 24 different genes, which were the most frequent genetic alterations among study subjects. We found 16 different variants among the genes that were present in 100% of the total cohort: SDHB (rs2746462), ALK (rs1670283), XPC (rs2958057), RECQL4 (rs4925828; rs11342077, rs398010167; rs2721190), DDB2 (rs326212), MEN1 (rs540012), AIP (rs4930199), ATM (rs659243), HNF1A (rs1169305), BRCA2 (rs206075; rs169547), ERCC5 (rs9514066; rs9514067), and FANCI (rs7183618). Conclusions: The technology of next-generation sequencing is a useful tool for studying the development and progression of gastric carcinoma in a high-throughput way. Our study revealed that early-onset gastric cancer has a different mutation frequency profile in certain genes compared to conventional subtype

A prospective pilot study on use of liquid crystal thermography to detect early breast cancer

Background: Breast cancer is the most common cancer in women. While mammography is the standard for early detection in women older than 50 years of age, there is no standard for younger women. The aim of this prospective pilot study was to assess liquid crystal contact thermography, using the Braster device, as a means for the early detection of breast cancer. The device is intended to be used as a complementary tool to standard of care (sonography, mammography, etc). Patients and Methods: A total of 274 consecutive women presenting at Polish breast centers for prophylactic breast examination were enrolled to receive thermography; 19 were excluded for errors in thermographic image acquisition. The women were divided according to age (n = 135, <50 years; n = 120, ≥50 years). A control population was included (n = 40, <50 years; n = 23, ≥50 years). The primary endpoint, stratified by age group, was the C-statistic for discrimination between breast cancer and noncancer. Results: In women with abnormal breast ultrasound (n = 95, <50 years; n = 87, ≥50 years), the C-statistic was 0.85 and 0.75, respectively (P = .20), for discrimination between breast cancer and noncancer. Sensitivity did not differ (P = .79) between the younger (82%) and older women (78%), while specificity was lower in the older women (60% vs 87%, P = .025). The false-positive rate was similar in women with normal and abnormal breast ultrasound. Positive thermographic result in women with Breast Imaging Reporting and Data System (BIRADS) 4A on ultrasound increased the probability of breast cancer by over 2-fold. Conversely, a negative thermographic result decreased the probability of cancer more than 3-fold. Breast size and structure did not affect the thermography performance. No adverse events were observed. Conclusions: Thermography performed well in women <50 years of age, while its specificity in women ≥50 years was inadequate. These promising findings suggest that the Braster device deserves further investigation as a supporting tool for the early detection of breast cancer in women younger than 50 years of age

Effectiveness of physiotherapy in patients with diabetes mellitus type 2 and low back pain

WSTĘP. Skuteczność leczenia w medycynie to uzyskanie poprawy stanu pacjenta w konsekwencji optymalnej terapii. Właściwe ukierunkowanie działań rehabilitacyjnych wiąże się z poznaniem przyczyń zespołu bólowego L-S oraz dostosowaniem działań do specyfiki chorych na cukrzycę typu 2. Odpowiednia modyfikacja postępowania pozwoli na uzyskanie maksymalnej skuteczności leczenia. Zdefiniowanie skuteczności rehabilitacji jest zagadnieniem niezwykle ważnym i niezbadanym. Wymaga wnikliwej analizy i wszechstronnej znajomości psychofizyczności człowieka. Niezbędne jest więc doskonalenie wiedzy dotyczącej nowych wytycznych procesu rehabilitacyjnego. Celem niniejszej pracy było określenie czynników determinujących skuteczność rehabilitacji w odniesieniu do pacjentów z zespołem bólowym kręgosłupa L-S chorych na cukrzycę typu 2. MATERIAŁ I METODY. Badaniem objęto grup 300 osób z bólami odcinka lędźwiowo-krzyżowego spowodowanego: zmianami zwyrodnieniowymi, dyskopatią, bólami przeciążeniowymi lub kręgozmykiem z zespołem metabolicznym, leczonych w Zamojskiej Klinice Rehabilitacji Wyższej Szkoły Zarządzania i Administracji w Zamościu w okresie od maja 2009 roku do marca 2010 roku. WYNIKI. Poprawa możliwości poruszania się u chorych na cukrzycę typu 2 jest porównywana z poprawą u pacjentów bez cukrzycy. Zmniejszenie natężenia dolegliwości bólowych u chorych na cukrzycę typu 2 jest porównywalne do poprawy u osób bez tej choroby. Polepszenie jakości życia u chorych na cukrzycę typu 2 jest porównywalne z poprawą u pacjentów bez cukrzycy. WNIOSKI. Chorzy na cukrzycę nie różnili się istotnie statystycznie w odczuciu poprawy w zakresie bólu, lokomocji i jakości życia od pacjentów bez cukrzycy. Cukrzyca typu 2 nie jest czynnikiem determinującym skuteczność rehabilitacji w odniesieniu do subiektywnych odczuć pacjentów z bólami L-S kręgosłupa. (Diabet. Prakt. 2010; 11, 6: 210&#8211;215)INTRODUCTION. Efficacy of treatment in medicine is to obtain the patient&#8217;s condition improved as a consequence of optimal treatment. Appropriate focus of rehabilitation is associated with pain syndrome to know the justification and adaptation to the specifics of patients with type 2 diabetes. Considerable modification of the procedure will result in maximum efficacy. Defining the effectiveness of rehabilitation is an issue extremely important and unexplored. Requires careful analysis and comprehensive knowledge of human psychophysical. It is therefore necessary to improve knowledge concerning the new guidelines, the process of rehabilitation. The goals: Identify the factors determining the effectiveness of rehabilitation for patients with low back pain patients with diabetes mellitus type 2. MATERIAL AND METHODS. The study included a group of 300 people with low back pain episode &#8212; due to cross: spondiloarthrosis, discopathy, spondylolisthesis and nerwus ischiadic with diabetes mellitus type 2 treated at the Rehabilitation Clinic of Uniwersity of Management and Administration in Zamość, the period from May 2009 to March 2010. RESULTS. Patients with type 2 diabetes was observed to improve the mobility is improved compared with patients without diabetes. Reduce the intensity of pain in patients with type 2 diabetes is comparable to the improvement in patients without diabetes. Improve the quality of life in patients with type 2 diabetes is comparable to the improvement of patients without diabetes. CONCLUSIONS. Patients with diabetes did not differ significantly in the perception of improvement in pain, locomotion, and the quality of life than patients without diabetes. Type 2 diabetes is not a factor in determining the effectiveness of rehabilitation in regard to subjective feelings of pain in patients with low back pain. (Diabet. Prakt. 2010; 11, 6: 210&#8211;215