Poziom wiedzy medycznej oraz zachowania zdrowotne pacjentów po zabiegu pomostowania aortalno-wieńcowego

Introduction. Coronary artery bypass grafting (CABG) is a method of myocardial revascularization. Patients after CABG require comprehensive care and rehabilitation. The aim of this study was to evaluate the level of medical knowledge and health behaviours of patients with coronary artery disease who underwent CABG. Data from this study will be used to develop educational workshops for this group of patients.Material and methods. The study included 106 patients after CABG hospitalized in a cardiac rehabilitation unit and was based on a highly standardized questionnaire developed by the authors. Statistical analysis included descriptive statistics, chi-square test, and correspondence analysis (p < 0.05 was considered statistically significant).Results. Medical knowledge of respondents was poor (one fourth did not know a single risk factor for coronary artery disease, only 33% knew the components of a cardioprotective diet, and 25%, 67% and 55% did not know normal values of blood pressure, cholesterol level, and glycaemia, respectively) and their health-related behaviours were inappropriate (76% did not make any major change in their lifestyle since the diagnosis, only 40% followed dietary recommendations, 61% forgot to take medications regularly, and only 60% measured blood pressure regularly). Analysis of the study data confirmed that poor medical knowledge and inappropriate health-related behaviours were related to low economic status, poor education, and inhabiting small cities/towns.Conclusions. Due to insufficient level of medical knowledge and inappropriate health-related behaviours of patients after CABG, it is necessary to incorporate health education within cardiac rehabilitation programs for this group of patients, with a particular focus on inequalities in health and disease.Wstęp. Pomostowanie aortalno-wieńcowe (CABG) jest jedną z metod rewaskularyzacji mięśnia sercowego. Chorzy po tym zabiegu wymagają kompleksowej opieki oraz rehabilitacji. Celem pracy było poznanie poziomu wiedzy medycznej oraz zachowań zdrowotnych pacjentów z chorobą niedokrwienną serca po przebytym zabiegu kardiochirurgicznym. Dane z pracy posłużą do opracowania warsztatów edukacyjnych dla tej grupy pacjentów.Materiał i metody. Badaniem objęto 106 pacjentów po zabiegu CABG hospitalizowanych na oddziale rehabilitacji kardiologicznej. Podstawą badania był autorski kwestionariusz obejmujący wywiad o wysokim poziomie standaryzacji. W analizie danych posłużono się statystykami opisowymi, a w celu badania zależności obliczano wartość statystyki χ2oraz zastosowano analizę korespondencji (za poziom istotności uznano < 0,05).Wyniki. Badani pacjenci odznaczają się małą wiedzą medyczną (1/4 nie zna ani jednego czynnika ryzyka choroby niedokrwiennej serca; zaledwie 33% zna zasady diety kardioprotekcyjnej; 25%, 67% i 55% nie zna prawidłowych wartości, odpowiednio, ciśnienia tętniczego, cholesterolemii i glikemii) oraz przejawiają niekorzystne zachowania zdrowotne (76% nie dokonała większych zmian w dotychczas prowadzonym stylu życia od momentu postawienia diagnozy; zaledwie 40% realizuje zalecenia dietetyczne; 61% zapomina o regularnym przyjmowaniu leków; tylko 60% regularnie mierzy ciśnienie tętnicze). Analiza danych potwierdziła, że małej wiedzy medycznej oraz niewłaściwym zachowaniom zdrowotnym sprzyjają gorsza sytuacja ekonomiczna, niskie wykształcenie badanych oraz zamieszkiwanie w małych miejscowościach.Wnioski. Ze względu na niewystarczający poziom wiedzy medycznej oraz niewłaściwie zachowania zdrowotne pacjentów po CABG niezbędne jest poszerzenie programu rehabilitacji kardiologicznej o edukację zdrowotną tej grupy pacjentów ze szczególnym zwróceniem uwagi na kwestię nierówności w zdrowiu i chorobie

Searching for Noninvasive Predictors of the Diagnosis and Monitoring of Eosinophilic Esophagitis—The Importance of Biomarkers of the Inflammatory Reaction Involving Eosinophils

Background: Invasive and costly endoscopic diagnosis is obligatory for the diagnosis and monitoring of eosinophilic esophagitis (EoE). This study aims to evaluate the usefulness of serum biomarkers involved in eosinophil-mediated inflammation in the management of EoE. Methods: A prospective cohort study was conducted in 58 patients with dysphagia. Each participant completed a health questionnaire, underwent esophagogastroduodenoscopy with esophageal biopsy for histopathological examination and assessment of total, inflammatory and fibrostenotic Eosinophilic Esophagitis Reference Score (EREFS). Serum levels of interleukin 5 (IL-5), interleukin 13 (IL-13), transforming growth factor β1 (TGF-β1), major basic protein (MBP), and eotaxin 3 were determined by enzyme immunoassays. Total of 16 patients meeting the histological criteria for EoE were treated with proton pump inhibitors for 8 weeks, and then the same diagnostics was performed again. Results: Statistically significantly higher concentrations of MBP and TGF-β1 were demonstrated in the group of patients with EoE, while MBP and eotaxin 3 correlated with the peak eosinophil count (PEC). Baseline MBP levels and eotaxin 3 after treatment significantly positively correlated with EREFS. There was a negative correlation between IL-13 and fibrostenotic EREFS. Additionally, after treatment, a negative correlation TGF-β1 was noted with the inflammatory EREFS and a positive correlation with the fibrostenotic EREFS. Conclusions: The potential role of MBP in predicting the diagnosis of EoE, eotaxin 3 in predicting the advancement and correlation of IL-13 and TGF-β1 in differentiating the inflammatory and fibrotic course of the disease may facilitate the management and individualization of EoE therapy

High-resolution manometry in diagnostics and evaluation of therapy effectiveness in patients with eosinophilic esophagitis – underestimated breakthrough or dead end?

Eosinophilic esophagitis (EoE) is a chronic disease with non-specific symptoms, among which dysphagia is a prevailing one. The observed increase of EoE rate, its chronic and recurrent character, as well as invasive follow-up examination (periodical panendoscopy with specimen collection for histopathology), compel optimization of both the diagnostics algorithm and disease monitoring through searching for new, unique methods and tools so far not applied, including high-resolution manometry (HRM). Mentioned investigations result from advances in comprehension of disease pathogenesis, in which it is suggested that development of a chronic inflammatory reaction of the esophageal wall may lead to consecutive fibrosis and motility disorders. In research published to date one manometric pattern characteristic for EoE was not obtained, whereas the obtained inconsistent and at times contradictory results do not correlate either with symptoms exacerbation or endoscopic scan. Numerous constraints of discussed studies as well as current knowledge in disease etiopathology and esophagus biomechanics prompt further investigation of HRM significance in diagnostics and therapy monitoring of patients with EoE

Esophageal Motility Disorders in the Natural History of Acid-Dependent Causes of Dysphagia and Their Influence on Patients’ Quality of Life—A Prospective Cohort Study

Background: Esophageal dysmotility may be the cause or a secondary effect of gastric acid-dependent diseases: erosive reflux disease (ERD), Schatzki ring (SR) and eosinophilic esophagitis (EoE). Methods: This study aims to compare concomitant dysphagia with ERD, SR and EoE, considering manometric patterns, their role in the natural history and their impact on assessing quality of life. Fifty-eight patients with dysphagia underwent high-resolution manometry and esophago-gastro-duodenoscopy (EGD) with an assessment of SR, ERD and sampling for EoE, completed a questionnaire with the Eating Assessment Tool (EAT-10) and the Gastrointestinal Quality of Life Index. Based on endoscopic images and the histopathological criterion of EoE (≥15 eosinophils/high-power field), patients were assigned to groups with ERD, EoE, SR and with normal endoscopic and histopathological images. In the data analysis, p ≤ 0.05 was considered statistically significant. This trial was registered with ClinicalTrials.gov (no. NCT04803162). Results: Both EoE, SR and ERD correlate with ineffective motility. In ERD, normal peristalsis precedes the development of the disease, unlike EoE, which develops later and leads to absent contractility. The development of SR is associated with disorders of the upper esophageal sphincter (UES). In the group with SR and ERD, UES insufficiency significantly reduces the quality of life. Patients with normal esophagus in EGD scored the lowest quality of life and those with SR had the most severe dysphagia. Conclusion: The esophageal motility disorders co-occurring with endoscopic and histological anomalies do not significantly affect the severity of dysphagia, however, in the case of patients with ERD and SR and concomitant UES insufficiency, this motor dysfunction has a significant impact on the reduction in the patients’ quality of life. Although no specific esophageal motility pattern typical of EoE, ERD and SR has been identified, comparative assessment of manometric features may have a potential role in differential diagnosis

Patent ductus arteriosus – not only apaediatric issue

The ductus arteriosus is a vascular structure of the foetal circulation that connects the great arteries and determines the blood flow from the pulmonary trunk to the aorta bypassing the pulmonary circulation. After birth, it comes to the functional and structural closure of the ductus arteriosus and the foetal circulation changes into circulation of adult type. Sometimes, however, physiological degradation of the duct after the first few weeks of life does not happen – this situation is called patent ductus arteriosus and accounts for approximately 10% of congenital heart defects. Patent ductus arteriosus may be asymptomatic or manifest itself with disturbances, mainly associated with the respiratory and circulatory systems, as well as disorders of other organs. A common clinical symptom is a characteristic continuous murmur, called machine-like murmur. The occurrence and severity of symptoms depend primarily on the size of the shunt through the duct and also on the age of the patient. The major complications of patent ductus arteriosus are bacterial endocarditis and pulmonary vascular disease. Treatment is based on the definitive closure of the ductus. During the first few weeks after birth, pharmacological closure with cyclooxygenase inhibitors (indomethacin, ibuprofen) is possible. Patent ductus arteriosus can also be managed with the use of non-invasive techniques (catheter procedures) or surgical treatment (a less invasive video-assisted thoracoscopy is also possible). The situation is different when there are complex anatomical heart defects in which the postnatally patent ductus arteriosus plays a different, beneficial role – these are so-called ductus-dependent defects. The management of such patients consists in maintaining the patency of the ductus arteriosus, because it determines the normal blood flow. There are also rare cases of premature (prenatal) closure of the ductus arteriosus, which may lead to the failure of foetal circulation