The assessment of microcirculation architecture in keloids and hypertrophic scars : videocapillaroscopy

The aim of the study was the evaluation in vivo of the differences between the microcirculatory characteristics of the scars (keloids and hypertrophic scars) and healthy skin. Twenty three patients with keloids and twenty with hypertrophic scars were included in the study, evaluating fifty six scar areas and twenty healthy skin areas by means of contact optical probe videocapillaroscopy. Capillary density, length and capillary distribution pattern (punctiform, reticular, directional) together with the presence of microhemorrhages and neoangiogenesis were studied. Capillary length, capillary distribution pattern and presence of neoangiogenesis were found to be significantly increased in keloids and hypertrophic scars compared with controls. There were also significant differences between scars at the active stage and the ones in the atrophic phase as regards capillary length and the degree of neoangiogenesis. Patients with keloids and hypertrophic scars showed in videocapillaroscopy a variety of microcirculatory changes, often clustered in a characteristic pattern of abnormally oriented, dilated capillaries and neoangiogenesis phenomena. This methodology is highly likely to be of value in the assessment and prognostication of keloids and hypertrophic scars outcome

Symptoms of chronic bronchitis in individuals without chronic obstructive pulmonary disease : prevalence, burden, and risk factors in southern Poland

Chronic bronchitis (CB) symptoms are commonly reported in individuals without chronic obstructive pulmonary disease (COPD), but CB is rarely diagnosed in this population. We aimed to determine the prevalence and burden of CB, as well as its risk factors, in a population of patients without COPD. Data from the "Health Action" program (a lung cancer prevention and health care improvement program conducted in Proszowice County, Poland) were used. All county inhabitants aged 40 years or older without COPD were invited to participate. As part of the program, a questionnaire was administered to assess CB symptoms and risk factors. Spirometry at baseline and after the bronchodilator test was also performed. CB symptoms were present in 9.1% of the 3558 participants. The prevalence of CB in the study population was 7.12% (95% CI, 6.70-7.56). Patients with CB had more dyspnea and more often received medical treatment for lung disease or were hospitalized for respiratory disorders than patients without CB. CB was associated with worse lung function and a worse score in the modified Medical Research Council Dyspnea Scale even after adjustment for possible confounders. In a multivariate analysis, male sex, age over 70 years, current smoking, passive exposure to tobacco smoke, gas or wood heating, occupational exposure to chemical agents, lower forced expiratory volume in 1 second, and asthma correlated with an increased risk of CB. CB symptoms are common in individuals without COPD aged 40 years or older and are associated with more dyspnea irrespective of lung function and comorbidities

Wpływ spalania biomasy i narażeń zawodowych na czynność płuc w losowej próbie populacyjnej mieszkańców Małopolski

Introduction: Risk factors other than tobacco smoking contribute to about 20% of chronic obstructive pulmonary disease cases. Exposure to these risk factors and their influence on lung function has not been adequately studied in the population of Malopolska. Material and methods: In random population sample of adults at least forty years old, residents of 2 districts of Malopolska, data on exposure to known and probable respiratory risk factors were collected using questionnaire. All subjects without contraindications performed pre- and post-bronchodilatator spirometry. Results: We analyzed data from 618 subjects; 94.8% subjects lived for longer than 6 months in a dwelling where stove using coal or wood has been used for cooking and/or heating. At the time of study as many as 32.5% subjects were still using coal or wood for cooking or heating. Coal or wood were used as fuel on average for more than 30 years; 67% of subjects have ever worked in professions carrying a risk of exposure to potential respiratory risk factors. We have identified an independent relationship of farming with lower FEV1/FVC values as well as increased chronic obstructive pulmonary disease risk. Conclusions: Significant proportion of Malopolska inhabitants has been exposed to risks associated with cooking or heating with coal or wood. In the studied population farming was related to increased risk of chronic obstructive respiratory disease

Factors affecting the choice of therapeutic regimens in asthma and chronic obstructive pulmonary disease patients and patient adherence to the therapies prescribed

Introduction: Chronic obstructive pulmonary disease (COPD) and asthma are the most common chronic respiratory diseases worldwide. At the moment, there is no information about the preferences of Polish specialists as regards the treatment of asthma and COPD or factors influencing the choice of particular treatment regimens. Aim: To determine the treatment options most commonly used by experienced pulmonologists and allergists for asthma and COPD and to identify the factors affecting the choice of a particular therapy. Material and methods: The survey included 224 doctors (pulmonologists and allergists) across Poland and concerned patients diagnosed with asthma (n = 4358) and COPD (n = 3062). Results: In the case of asthma, the most common therapy applied was inhaled glucocorticosteroids and long-acting \beta2 agonists. According to 27.2% of doctors, combination therapy was used in 70-80% of patients while 23.7% declared that the proportion of patients receiving such a treatment exceeded 80%. In the case of COPD, anticholinergics were most frequently prescribed when inhaled glucocorticosteroids and long-acting \beta2 agonists had proved insufficient. According to 21% of specialists, the percentage of patients treated so was 41-50%, while 19% declared the use of this treatment in 71-80% of patients. Conclusions: The most common treatments for asthma and COPD in Poland are inhaled glucocorticosteroids and long-acting \beta2 agonists. The main factors influencing treatment decisions are the current GINA and GOLD recommendations as well as patients' age, comorbidities, and price of treatment

Effects of biomass combustion and occupational exposures on lung function in random population sample of Malopolska inhabitants

Introduction: Risk factors other than tobacco smoking contribute to about 20% of chronic obstructive pulmonary disease cases. Exposure to these risk factors and their influence on lung function has not been adequately studied in the population of Malopolska. Material and methods: In random population sample of adults at least forty years old, residents of 2 districts of Malopolska, data on exposure to known and probable respiratory risk factors were collected using questionnaire. All subjects without contraindications performed pre- and post-bronchodilatator spirometry. Results: We analyzed data from 618 subjects; 94,8% subjects lived for longer than 6 months in a dwelling where stove using coal or wood has been used for cooking and/or heating. At the time of study as many as 32.5% subjects were still using coal or wood for cooking or heating. Coal or wood were used as fuel on average for more than 30 years; 67% of subjects have ever worked in professions carrying a risk of exposure to potential respiratory risk factors. We have identified an independent relationship of farming with lower FEV1/FVC values as well as increased chronic obstructive pulmonary disease risk. Conclusions: Significant proportion of Malopolska inhabitants has been exposed to risks associated with cooking or heating with coal or wood. In the studied population farming was related to increased risk of chronic obstructive respiratory disease.Wstęp: W około 20% przypadków przewlekłej obturacyjnej choroby płuc w patogenezie choroby biorą udział czynniki ryzyka inne niż palenie tytoniu. Narażenie na te czynniki i ich wpływ na czynność płuc w populacji Małopolski nie zostało dokładnie zbadane. Materiał i metody: W losowo dobranej próbie populacyjnej z 2 powiatów Małopolski, w wieku co najmniej 40 lat, zebrano za pomocą kwestionariusza szczegółowe dane dotyczące narażeń na znane i przypuszczalne czynniki ryzyka chorób układu oddechowego oraz wykonano spirometrię przed i po podaniu leku rozkurczającego oskrzela. Wyniki: Analizą objęto dane od 618 badanych; 94,8% badanych dłużej niż 6 miesięcy w życiu mieszkało w domu, w którym używano węgla do gotowania lub ogrzewania. W czasie badania aż 32,5% badanych wciąż stosowało węgiel lub drewno do gotowania i/lub ogrzewania. Średni czas używania węgla i drewna jako źródła opału przekraczał 30 lat; 67% badanych wykonywało w życiu zawód wiążący się z narażeniem na czynniki potencjalnie wpływające szkodliwie na układ oddechowy. Stwierdzono niezależny od innych czynników ryzyka wpływ pracy na roli na mniejszą wartość FEV1/FVC oraz większe ryzyko przewlekłej obturacyjnej choroby płuc. Wnioski: Znaczący odsetek mieszkańców Małopolski był narażony na spalanie węgla i drewna oraz narażenia zawodowe. W badanej populacji praca na roli wiązała się z większym ryzykiem przewlekłej obturacyjnej choroby płuc

Oestrogens and skin : slowdown of skin aging

Starzenie się skóry będące wynikiem upływu czasu, jak również działania wielu czynników zewnętrznych (UV, palenie tytoniu, dieta, stres) i wewnętrznych (hipoestrogenizm, niedobór hormonów podwzgórza) upośledza ją i ogranicza wiele jej funkcji. Zaburzenia gospodarki hormonalnej są ważnym i stosunkowo dobrze poznanym czynnikiem wpływającym istotnie na proces starzenia się skóry. Podkreślana jest zwłaszcza rola estrogenów, których stężenie zmniejsza się w okresie menopauzy, czemu towarzyszy nasilenie procesów starzenia zarówno związanych z wiekiem, jak i spowodowanych działaniem czynników środowiskowych. Precyzyjny mechanizm indukcji produkcji kolagenu przez estrogeny nie jest znany. Wydaje się, że może on być związany z wpływem na stężenie TGF-β – czynnika wzrostu promującego produkcję kolagenu przez fibroblasty. Wyniki wielu badań potwierdzają korzystny wpływ egzogennych estrogenów na naskórek – zwiększają jego nawilżenie, zmniejszają przeznaskórkową utratę wody, zwiększają stężenie lipidów powierzchniowych, poprawiają funkcję skóry jako bariery i zapobiegają suchości. Zdecydowana większość badań podkreśla protekcyjny wpływ terapii hormonalnej (HT) na zjawiska związane ze starzeniem się skóry, dokumentują ich korzystny wpływ nie tylko na kolagen, ale i na elastyczność skóry oraz funkcję niektórych przydatków skóry. Jednak niebezpieczeństwo związane ze stosowaniem HT, szczególnie w grupach kobiet, u których stwierdza się dodatkowe czynniki predysponujące do rozwoju schorzeń o potwierdzonym związku z taką terapią, powoduje, że nie pozwala to na rozszerzenie wskazań do stosowania HT w celu poprawy funkcji i wyglądu skóry.Skin aging due to the passage of time and influence of many external (ultraviolet radiation, tobacco smoke, diet, stress) and internal (hypoestrogenism, lack of hypothalamus hormones) factors handicaps many skin functions. Disturbances of hormone management are important and well known agents responsible for skin aging. Particularly emphasized is the role of oestrogens, whose concentration becomes low during the menopausal period, causing intensification of skin aging. A distinct mechanism of induction of production of collagen via oestrogens is not known. There is a possibility of an influence on TGF-β (transforming growth factor beta), which stimulates fibroblasts to produce collagen. The data of many studies confirm the beneficial influence of exogenous oestrogens on the epidermis by decreasing transepidermal water loss, enhancing moisturizing abilities and surface lipid levels, improving skin function as a barrier and preventing dryness. Most studies give weight to the protective impact of hormone replacement therapy (HRT) on skin aging. Many studies have testified to good effects not only on collagen but also on skin elasticity and functions of some skin adnexa. However, a hazard connected with HRT in women with additional predisposing factors to development of diseases with a proven association with this therapy rule out the extension of use of HRT to improve skin functions and appearance

Can alveolar hypoventilation due to kyphoscoliosis be a contraindication to driving?

Road accidents are among the main fatalities worldwide and drowsy driving is a significant cause of road deaths where drivers are at fault. There are well known diseases which impair sensory and cognitive functions and can cause sleepiness during driving. Such diseases can be an important contraindication to driving because they may have an adverse effect on its safety. Thus, medical examinations for drivers should also be directed at identifying any possible conditions posing risks for driving safety. Occupational medicine specialists should look for symptoms of locomotor and sleep-related breathing disorders as these are medical conditions which could preclude a person from driving. In this case report, the authors describe a professional driver with chest deformity and present a pioneering attempt at assessing his medical fitness to drive. It is also explained why scoliosis can impair driving ability and how it should be diagnosed and treated. Finally, the authors describe how they used driving simulator tests as part of their diagnosis and suggest a relevant treatment regimen