Identification of clinical risk factors of atrial fibrillation in congestive heart failure

Background: Factors associated with the development of atrial fibrillation (AF) in generalpopulation have been described, but it is still unknown whether the same risk factors applyto heart failure (HF) patients. The aim of this study was to identify clinical factors related tovarious forms of AF in HF patients.Methods: The clinical and echocardiographic characteristics were assessed in 155 HF patients:50 with sinus rhythm, 52 with non-permanent AF, and 53 with permanent AF.Results: Multivariate logistic regression analysis showed that the increase in the NYHAclass was an independent risk factor for both forms of AF. The occurrence of permanent AF incomparison to sinus rhythm group was independently associated with hs-C-reactive protein(CRP) elevation above 1 mg/dL (OR 1.87, 95% CI 1.05–3.35), left atrial dimension above4 cm (OR 3.78, 95% CI 1.29–11.06) and tricuspid maximal pressure gradient elevation above35 mm Hg (OR 5.01, 95% CI 1.38–18.27). The presence of coronary disease was independentlyassociated with less frequent occurrence of permanent AF in comparison to sinus rhythm group(OR 0.21, 95% CI 0.06–0.67).Conclusions: More advanced congestive HF was associated with presence of both types of AF.Non-ischemic etiology of HF and elevated CRP are independently associated with permanentAF compared to sinus rhythm. Left ventricular diastolic dysfunction indicators (increasedtricuspid maximal pressure gradient and left artial dimension) are independently associatedwith permanent AF

Friedewald formula may be used to calculate non-HDL-C from LDL-C and TG

BackgroundThe Friedewald formula (FF) was originally designed 50 years ago and has been in use to this day despite better methods for estimating LDL cholesterol (LDL-C). Its success was mainly due to its simplicity. Nowadays most laboratories determine or can determine LDL-C by the direct method. The SCORE2 tables, recommended by the European Society of Cardiology, are based on non-HDL cholesterol (non-HDL-C). To calculate its value, one needs to know the values of total cholesterol (TC) and HDL-C. The presented idea is to use the FF to calculate non-HDL-C based on the values of LDL-C and TG instead of TC and HDL-C.Methods and findingsBased on database of 26,914 laboratory results, covering the complete lipid panel, the error regarding non-HDL-C values calculated in both ways (recommended and proposed) was determined. The average error in the LDL-C value calculated with the FF compared to the LDL-C value measured in the laboratory is 9.77%, while for non-HDL-C the error between the calculated and laboratory-determined value amounts to 8.88%. The proposed transformation of the FF also yields a much lower percentage of error calculations. Both LDL-C and non-HDL-C (calculated) in our material are strongly correlated with LDL-C and non-HDL-C (measured) values of r = 0.965 (p < 0.000) and r = 0.962 (p < 0.000), respectively.ConclusionNon-HDL-C may be calculated based on the values of LDL-C and TG (without the need to determine the levels of TC and HDL-C). The proposed calculation may greatly reduce the cost of testing, given the price of a complete lipid profile

Gruźlica w praktyce lekarza rodzinnego

Tuberculosis is a disease of well-known etiology and epidemiology, with refined diagnosticand therapeutic procedures. Apart from the „multidrug-resistant tuberculosis”, fortunatelystill quite rare (in 2019 — about 1% new cases in Poland), detected early enough shouldbe curable. Its diagnosis, or at least suspicion, is one of the tasks of the family doctor. Theaim of the work is to refresh the knowledge in the field of diagnostics and epidemiology oftuberculosis, systematizing them in a practical way, easy for use in a primary care.Gruźlica jest chorobą o dobr ze poznanej etiologii, epidemiologii i dopracowanych sche - matach diagnostycznych i terapeutycznych. Abstrahując od, na sz częście wciąż jeszcze dość rzadkich, przypadków gruźlicy wielolekoopornej (w 2019 roku w Polsce było to ok. 1% przypadków) odpowiednio wcześnie wykryta powinna być w pełni uleczalna. Jej rozpoznanie, a przynajmniej postawienie takiego podejrzenia, jest jednym z zadań lekarza rodzinnego. Celem pracy jest odświeżenie wiadomości z zakresu diagnostyki i epidemiologii gruźlicy oraz praktyczna systematyzacja, łatwa do wykorzystania w praktyce lekarza rodzinneg

Original articleAnalysis of selected risk factors of coronary artery disease in a healthy population aged 35-55 years

Background: This report comprises an analysis of results of examinations performed as a part of a cardiovascular disease prevention programme funded by the National Health Fund. Aim: To determine the relationship between body mass index (BMI) and blood pressure, blood glucose and lipid metabolism abnormalities in an ethnically homogeneous population of males and females aged 35 to 55 years with sense of full health without prior diagnosis of cardiovascular disease or diabetes. Methods: The study was carried out in the population of a 175,000-resident city during 9 months, involving 1080 subjects (696 females and 384 males) aged 35 to 55 years (mean age – 47.2±5.4). The following variables were assessed: systolic and diastolic blood pressure, body weight and height, BMI, fasting blood glucose, total cholesterol, triglycerides and HDL cholesterol levels. Results: The studied male population had significantly higher blood pressure, blood glucose, total cholesterol, triglycerides and lower HDL cholesterol levels compared to age-matched females. The female population was found to have a more prominent relationship between increased BMI and blood pressure, blood glucose and serum cholesterol levels than males. Significant differences in favour of females regarding systolic blood pressure, blood glucose and serum cholesterol failed to be present in the obese women subgroup (no statistically significant differences were found compared to obese males). In females aged 45 to 55 years, significantly higher body weight, blood pressure as well as blood glucose, cholesterol and triglyceride levels were observed than in younger women (35-45 years old). Conclusions: Overweight and obesity are associated with increase of arterial blood pressure, lipid metabolism disturbances and elevation of blood glucose. The relationship between BMI and studied risk factors was influenced by age and gender. Menopause is associated with increasing body weight and unfavourable evolution of studied risk factors.Wstęp: Praca stanowi analizę wyników badań uzyskanych w ramach programu profilaktyki chorób układu krążenia finansowanego przez Narodowy Fundusz Zdrowia. Cel: Określenie zależności między wskaźnikiem masy ciała (ang. body mass index, BMI) a wartościami ciśnienia tętniczego krwi, glikemią i zaburzeniami lipidowymi występującymi w jednolitej etnicznie populacji kobiet i mężczyzn od 35. do 55. roku życia, z poczuciem pełnego zdrowia, u których dotychczas nie rozpoznano chorób układu krążenia i cukrzycy. Metodyka: Badanie przeprowadzono w populacji 175-tysięcznego miasta w ciągu 9 mies., obejmując analizą 1080 osób (696 kobiet i 384 mężczyzn) w wieku 35–55 lat (średnia wieku 47,2±5,4). Oceniono pomiary wartości skurczowej i rozkurczowej ciśnienia tętniczego krwi, masę i wysokość ciała, BMI, stężenie glukozy na czczo, cholesterolu całkowitego, trójglicerydów i frakcji HDL cholesterolu. Wyniki: W badanej populacji mężczyzn stwierdzono znamiennie wyższe wartości ciśnienia tętniczego, stężenia glukozy, cholesterolu całkowitego, trójglicerydów i niższe stężenia frakcji HDL cholesterolu w porównaniu z populacją kobiet w tym samym przedziale wiekowym. W populacji kobiet obserwowano bardziej wyraźną niż w grupie mężczyzn zależność między wzrostem wskaźnika BMI a wartościami ciśnienia tętniczego krwi, stężeniem glukozy i cholesterolu w surowicy. Znamienne, korzystne dla płci żeńskiej, różnice w wartościach skurczowego ciśnienia tętniczego krwi, stężenia glukozy i cholesterolu w surowicy krwi nie były widoczne w podgrupie kobiet otyłych (brak istotnych statystycznie różnic w porównaniu z podgrupą otyłych mężczyzn). Wśród kobiet w wieku 45–55 lat obserwowano znamiennie wyższe wartości masy ciała, ciśnienia tętniczego krwi oraz stężenia glukozy, cholesterolu i trójglicerydów w porównaniu z kobietami młodszymi (35–45 lat). Wnioski: Nadwaga i otyłość łączą się ze wzrostem wartości ciśnienia tętniczego krwi, z zaburzeniami lipidowymi i wzrostem stężenia glukozy w surowicy krwi. Związek między wskaźnikiem BMI a badanymi czynnikami ryzyka zależy od wieku i płci badanych osób. Okres menopauzy wiąże się ze wzrostem masy ciała i niekorzystnymi zmianami ocenianych czynników ryzyka

The effect of isocaloric, energy-restrictive, KETOgenic diet on metabolism, inflammation, nutrition deficiencies and oxidative stress in women with overweight and obesity (KETO-MINOX): Study protocol

In recent times, the prevalence of obesity increases, reaching an epidemic scale. A new factor supporting a weight gain is a current coronaviros (COVID-19) pandemic, associated with reduced physical activity, high stress and overeating, which resulted in 2-5 kg weight gain in 20 % of the American population within a few months 1. Elevated body weight is a risk factor in developing several diseases such as diabetes, hypertension and cancer. Therefore, obesity management solutions, such as diet therapy, are needed. The critical issue is to choose the most appropriate diet to obtain an efficient outcome in losing weight without experiencing adverse effects and a decrease in general health. A ketogenic diet, an auxiliary therapy for epilepsy, is recently one of the options commonly used for losing weight by individuals with overweight, tempted by the commercials and internet influencers. However, there is limited knowledge about the effect of this diet on human health. To date, the majority of studies were conducted with a very low-calorie regime applied before the bariatric surgeries, which itself may affect the loss of body weight. In most studies, the control diets were missing. Considering that a ketogenic diet is an extremely eliminating diet, there is a risk of nutritional deficiencies after following it. Therefore, there is a strong need for more in-depth and comprehensive elucidation of the safety and physiological effects of the energy-restricted ketogenic diet used for weight loss in individuals with overweight and obese.This Project aims to evaluate the effectiveness of the eight-week, isocaloric, energy-restricted, ketogenic diet as a weight management solution in women with overweight and obesity compared to the standard, balanced diet with the same calorie content

Mortality among the homeless: Causes and meteorological relationships.

The homeless constitute a subpopulation particularly exposed to atmospheric conditions, which, in the temperate climate zone, can result in both cold and heat stress leading to the increased mortality hazard. Environmental conditions have become a significant independent risk factor for mortality from specific causes, including circulatory or respiratory diseases. It is known that this group is particularly prone to some addictions, has a shorter life span, its members often die of different causes than those of the general population and may be especially vulnerable to the influence of weather conditions.The retrospective analysis is based on data concerning 615 homeless people, out of which 176 died in the analyzed period (2010-2016). Data for the study was collected in the city of Olsztyn, located in north-east Poland, temperate climatic zone of transitional type. To characterize weather conditions, meteorological data including daily minimum and maximum temperatures and the Universal Thermal Climate Index (UTCI) were used.The average life span of a homeless person was shorter by about 17.5 years than that recorded for the general population. The average age at death of a homeless male was 56.27 years old (SD 10.38), and 52.00 years old (SD 9.85) of a homeless female. The most frequent causes of death were circulatory system diseases (33.80%). A large number of deaths were attributable to smoking (47.18%), whereas a small number was caused by infectious diseases, while a relatively large proportion of deaths were due to tuberculosis (2.15%). Most deaths occurred in the conditions of cold stress (of different intensity). Deaths caused by hypothermia were thirteen-fold more frequently recorded among the homeless than for the general population. A relative risk of death for a homeless person even in moderate cold stress conditions is higher (RR = 1.84) than in thermoneutral conditions.Our results indicate excessive mortality among the homeless as well as the weak and rather typical influence of atmospheric conditions on mortality rates in this subpopulation, except for a greater risk of cold related deaths than in the general population. UTCI may serve as a useful tool to predict death risk in this group of people

Coping Styles and Alcohol Dependence among Homeless People.

BACKGROUND AND OBJECTIVES:The ways in which homeless individuals cope with stress may differ from those relied upon by the members of the general population and these differences may either be the result or the cause of their living conditions. The aim of the study was to determine the preferred coping style among the homeless and its relationship with alcohol dependence. METHODS:The study included 78 homeless individuals and involved the collection of demographic, sociological, psychological and medical data from each participant. Coping styles relied upon when dealing with stressful situations were assessed using a Polish adaptation of the Coping Inventory for Stressful Situations. Alcohol dependence was assessed using the Michigan Alcoholism Screening Test (MAST) and a quantitative analysis of alcohol consumption. RESULTS:Men accounted for 91.93% of the study population. Nearly 75% of the subjects met the alcohol dependence criterion. Significant relationships were observed between the individual's age, preferred coping style and alcohol consumption level. As an individual's age increased, the use of emotion-oriented coping styles decreased, while an increase in alcohol consumption was associated with a more frequent use of emotion- and avoidance-oriented strategies. CONCLUSIONS:The findings of this study, similarly to those of many other studies of homeless individuals but investigating other areas (e.g. epidemiology of tuberculosis and traumatic injuries), are an exaggerated representation of associations observed in the general population. The results describe a group of people living on the margins of the society, often suffering from extremely advanced alcoholism, with clear evident psychodegradation. The presence of specific ways of coping with stress related to excessive alcohol consumption in this group of individuals may interfere with active participation in support programmes provided for the homeless and may further exacerbate their problems

Antihypertensive efficacy and tolerability of aliskiren/hydrochlorothiazide (HCT) single-pill combinations in patients who are non-responsive to HCT 25 mg alone

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVE: Thiazide diuretics such as hydrochlorothiazide (HCT) are a widely used first-line treatment for hypertension, but most patients will not achieve blood pressure (BP) control with HCT alone and so will require combination therapy. In this study the efficacy, safety and tolerability of a single-pill combination (SPC) of the direct renin inhibitor aliskiren with HCT were investigated in patients non-responsive to HCT 25 mg therapy. METHODS: In this study, 722 patients with hypertension and an inadequate response to 4 weeks of HCT 25 mg (mean sitting diastolic BP > or =90 and <110 mmHg) were randomized to once-daily, double-blind treatment for 8 weeks with an SPC of aliskiren/HCT 300/25 mg or 150/25 mg, or continued HCT 25 mg monotherapy. Least-squares mean changes in mean sitting systolic/diastolic BP (msSBP/DBP) from double-blind baseline were analyzed for the ITT population at week 8 endpoint. RESULTS: Aliskiren/HCT 300/25 mg and 150/25 mg SPCs lowered msSBP/DBP from baseline by 16.7/10.7 and 12.9/8.5 mmHg, respectively, both significantly greater reductions than HCT 25 mg alone (7.1/4.8 mmHg; both p < 0.001). Rates of BP control (<140/90 mmHg) were also significantly higher with aliskiren/HCT 300/25 mg (58%) and 150/25 mg (49%) than with HCT (26%; both p < 0.001). Aliskiren/HCT 300/25 mg provided significantly greater msSBP/DBP reductions and rates of BP control than the 150/25 mg SPC dose (all p < 0.05). Aliskiren/HCT SPC treatment showed similar tolerability to HCT alone and a numerically lower incidence of hypokalemia (serum potassium <3.5 mmol/L; aliskiren/HCT, 1.3-2.2%: HCT alone, 3.4%). CONCLUSION: Aliskiren/HCT SPCs provide clinically significant BP reductions and improved BP control rates in patients who are non-responsive to HCT 25 mg monotherapy. Limitations of the study were the mainly Caucasian patient population and the non-responder design