Factors associated with adherence in patients with type 2 diabetes mellitus

Introduction. Only 50 - 75% of patients surveyed adhere to therapeutic recommendations in the treatment of chronic diseases. It is estimated that half of the patients discontinue therapy after one year from the start of treatment. Failure to comply with therapeutic recommendations often leads to complications of diabetes. New methods are now being sought to help diabetics adhere to the recommendations of the therapeutic team. According to the World Health Organization, interventions to improve adherence have a greater impact on health than the development of treatment. The aim of the study was to analyze the degree of adaptation to the therapeutic recommendations of patients with type 2 diabetes. Material and methods. 150 patients (96 women) 65.2 ± 11.8 years of age who were treated for exacerbation of type 2 diabetes were examined with their own questionnaire regarding compliance with the therapeutic recommendations and a standardized HBI (Health Behavior Inventory) questionnaire to assess health behaviors. Results. A high degree of compliance with pharmacological recommendations was presented by 30%, the average 42,7%, and low 27,3% patients. High level of adherence was presented by people aged 50-69 (p 7% (7.0 vs. 6.6). The level of adherence to recommendations was the lowest in patients treated with the combination regimen (tablets+insulin; p=0.024). High level of health behaviors was presented more often by women compared to men (108 vs. 103), older people compared to younger ones (age 60-69 HBI=109.1 vs. age up to 49 years HBI=93.3), pensioners compared to economically active people or unemployed (108.3 vs. 101.1 vs. 92.3). In multivariate analysis, the independent predictors of adherence to pharmacological therapeutic recommendations are the absence of co-morbidities and older age (β=0.212, p=0.005). Conclusions. Patients with diabetes have a moderate level of adherence and the compliance with health behaviors. An independent predictor which has a positive influence on the HBI is the old age (the older the patient, the better the level of adherence). The predictor which reduced the level of adherence and the HBI was the absence of comorbidities

Metallothionein 2A genetic polymorphisms and risk of ductal breast cancer

Metallothioneins (MTs) are a family of metal binding proteins that play an important role in cellular processes such as proliferation and apoptosis. Metallothionein 2A is the most expressed MT isoform in the breast cells. A number of studies have demonstrated increased MT2A expression in various human tumors, including breast cancer. We carried out an association study to examine whether MT2A gene polymorphisms are associated with risk of breast cancer. Information on lifestyle risk factors was collected via a self-administered questionnaire. Genotyping was conducted using polymerase chain reaction–restriction fragment length polymorphism technique. Three single nucleotide polymorphisms (SNP) rs28366003, rs1610216 and rs10636 were genotyped in 534 breast cancer cases and 556 population controls. One SNP in MT2A (rs28366003) showed a positive association with breast cancer. Compared with homozygous common allele carriers, heterozygous for the G variant [odds ratio (OR) = 1.92, 95 % confidence interval (CI):1.28–2.81, p trend <0.01; the OR assuming a dominant model 1.93 (95 % CI: 1.29–2.89, p dominant <0.02) after adjustment for age, family history, smoking status, BMI, menarche, parity, menopausal status and use of contraceptive and menopausal hormones] had a significantly increased risk of breast cancer in Polish population, as well as women with haplotypes, including variant allele of rs28366003 SNP (OR = 1.58, CI: 0.41–6.33, p global = 0.03). Our data suggest that the rs28366003 SNP in MT2A is associated with risk of breast cancer in Polish population.This work was supported, in part, by the statutory fund for the Department of Cytobiochemistry, University of Łód

Association between the c.*229C>T polymorphism of the topoisomerase IIb binding protein 1 (TopBP1) gene and breast cancer

Topoisomerase IIb binding protein 1 (TopBP1) is involved in cell survival, DNA replication, DNA damage repair and cell cycle checkpoint control. The biological function of TopBP1 and its close relation with BRCA1 prompted us to investigate whether alterations in the TopBP1 gene can influence the risk of breast cancer. The aim of this study was to examine the association between five polymorphisms (rs185903567, rs116645643, rs115160714, rs116195487, and rs112843513) located in the 30UTR region of the TopBP1 gene and breast cancer risk as well as allele-specific gene expression. Five hundred thirty-four breast cancer patients and 556 population controls were genotyped for these SNPs. Allele-specific Top- BP1 mRNA and protein expressions were determined by using real time PCR and western blotting methods, respectively. Only one SNP (rs115160714) showed an association with breast cancer. Compared to homozygous common allele carriers, heterozygous and homozygous for the T variant had significantly increased risk of breast cancer (adjusted odds ratio = 3.81, 95 % confidence interval: 1.63–8.34, p = 0.001). Mean TopBP1 mRNA and protein expression were higher in the individuals with the CT or TT genotype. There was a significant association between the rs115160714 and tumor grade and stage. Most carriers of minor allele had a high grade (G3) tumors classified as T2-T4N1M0. Our study raises a possibility that a genetic variation of TopBP1 may be implicated in the etiology of breast cancer

Early nonhaematological toxicity after autologous hematopoietic stem cell transplantation in elderly lymphoma patients

Chemioterapia w wysokich dawkach (HDT) z autologicznym przeszczepieniem szpiku (AutoHCT) jest leczeniem z wyboru w przypadkach nowotworów hematologicznych, w których standardowa terapia nie pozwala na uzyskanie dobrych wyników leczenia. Pacjenci powyżej 60. roku życia ze współistniejącymi chorobami są wyłączani z HDT ze względu na toksyczność wielonarządową i śmiertelność okołoprzeszczepową. Celem badania była analiza częstości i stopnia nasilenia powikłań narządowych we wczesnym okresie, do 30 dni po autotransplantacji, u chorych na chłoniaki w wieku 60 lat i więcej. W latach 2005–2011 zakwalifikowano do leczenia mieloablacyjnego 44 chorych. Mediana wieku wynosiła 62 lata (zakres: 60–67). Chemioterapię BEAM (karmustyna, etopozyd, cytarabina, melfalan) podano 16 chorym, melfalan 200 otrzymało 22 chorych, 6 chorym podano inne kondycjonowanie (cytarabina, melfalan lub cyklofosfamid). W 32% przypadków stwierdzono choroby współistniejące, w tym w 71% choroby sercowo-naczyniowe. Wczesną wielonarządową toksyczność stwierdzono w 84% przypadków. Najczęstszym powikłaniem były zaburzenia żołądkowo-jelitowe (77% chorych). Biegunka III-IV stopnia wystąpiła u 24 chorych (55%), przedłużone powyżej 7 dni wymioty u 17 chorych (40%). Zmiany śluzówkowe jamy ustnej III-IV stopnia obserwowano u 15 chorych (34%). Gorączka neutropeniczna (59%), z sepsą wystąpiła u 1 chorego (2%). Powikłania kardiologiczne stwierdzono u 4 chorych (9%). Mediana czasu hospitalizacji wynosiła 21 dni (16–44). Jeden chory zmarł z powodu toksyczności związanej z autotransplantacją (2%). We wczesnym okresie potransplantacyjnym, u chorych powyżej 60. roku HDT towarzyszy znaczna toksyczność narządowa. Do najczęstszych niehematologicznych objawów ubocznych leczenia mieloablacyjnego należą powikłania z przewodu pokarmowego, gorączka neutropeniczna, powikłania kardiologiczne. Przy niskiej śmiertelności okołoprzeszczepowej (2%) HDT jest procedurą bezpieczną dla osób starszych.Early non-haematological toxicity of high dose therapy (HDT) and autologous haematopoietic cell transplantation (autoHCT) can be more hazardous in older patients (pts) with comorbidities. The aim of the study was to analyze incidence and grade of the organ-related early complications up to 30 days post-transplant period in elderly lymphoma patients. Between January 2005 and November 2011, 44 consecutive lymphoma pts underwent HDT followed by autoHCT. Median age of pts was 62 years (range 60–67). Conditioning regimens were: BEAM(carmustine, etoposide, cytarabine, melphalan) in 16, melphalan 200 in 22, cytarabine, melphalan or cyclophosphamide – in 6 pts. 32% pts had comorbidities: in 71% cardiovascular. Early non-haematologic complications within 30 days after autoHCT were reported in 84% of pts. The most common events were gastrointestinal (77%): 55% pts had prolonged (more than 7 days) diarrhoea grade III—IV, nausea and vomiting occurred in 40% of pts, 50% of pts demonstrated mucositis (grade III—IV in 34% of pts). Neutropenic fever was reported in 59% of pts with sepsis in 1.9% of pts. Cardiac events occurred in 9% of pts. Median hospitalization was 21 days (range 16—45). One patient died from transplanted related toxicity. HDT resulted in high incidence of non-hematologic toxicity in elderly patients during early post-transplant period. The toxicity of this procedure is acceptable, with mortality rate of only 2% in the elderly transplanted patients. The most common toxicities were: neutropenic fever, gastrointestinal toxicity and cardiac complication

Analysis of ibrutinib efficacy in a subgroup of chronic lymphocytic leukemia patients with 17p deletion: observational study of the Polish Adult Leukemia Group (PALG)

BackgroundThe 17p deletion is regarded as the strongest poor prognostic factor in chronic lymphocytic leukemia (CLL). Results of recently performed clinical trials have suggested that ibrutinib significantly improves the outcome in this patient group.AimThe study aimed at analyzing the efficacy and adverse events profile of ibrutinib monotherapy in CLL patients with 17p deletion treated in routine clinical practice outside clinical trials.Materials and MethodsClinical response and adverse events profile of ibrutinib monotherapy were assessed in thirty-five CLL patients with 17p deletion treated within the ibrutinib named patients program in Poland.ResultsOverall response rate was 80% (28/35 patients) with median observation time of 24.2 months (range 0,1 – 30,9). Complete remission was observed in 5 patients (14.3%), partial remission in 11 (31.4%), partial remission with lymphocytosis in 13 (37.1%), whereas stable disease and progression was noted in 4 (11.4%) and 1 (2.9%) respectively. Response was not assessed in 1 patient. Median progression-free survival was 29.5 months, whereas median overall survival was not reached. Eleven patients died (7 because of infection, 1 of CLL progression, 1 of sudden cardiac death, 1 of disseminated breast cancer and 1 of unknown causes). In 13 patients (37.1%) at least one 3 or 4 grade adverse event occurred. In 11 patients (31.4%) the treatment was temporary withheld or the dose reduced due to adverse events.ConclusionIbrutinib is characterized by high clinical efficacy and acceptable toxicity in CLL patients with 17p deletion in daily clinical practice

Effects of Partial Replacement of Soybean Meal with Defatted Hermetia illucens Meal in the Diet of Laying Hens on Performance, Dietary Egg Quality, and Serum Biochemical and Redox Indices

This study was carried out on 96 caged Bovans Brown laying hens at an initial age of 25 weeks, which were randomly assigned to four experimental groups of 12 replicates (cages) of two hens per cage. The control group hens received a diet containing 20% soybean meal (SBM), without Hermetia illucens larvae meal (HIM) content. The hens in the experimental groups received a diet containing defatted HIM at levels of 5, 10, and 15% (HIM 5%, HIM 10%, and HIM 15%, respectively), at the expense of a proportionally decreasing content of SBM. During the 12-week experiment, the laying performance, biochemical and redox blood indices, and liver condition were examined. The cholesterol level, fatty acid profile, and malondialdehyde content in egg yolks were also evaluated to determine the dietary quality of the eggs. The inclusion of HIM at any level in the diet did not affect the laying performance parameters (p &gt; 0.05). Increased serum Ca and uric acid contents were observed. There was no effect on the redox indices in plasma. The number of hepatocytes was decreased in the HIM-fed groups. The level of cholesterol in yolks was reduced, and the fatty acid profile showed significant changes. Despite the high lauric acid content in the H. illucens meal, it was present in trace amounts in yolks. In the HIM-fed groups, the levels of saturated fatty acids increased significantly, whereas those of unsaturated fatty acids decreased in the yolks in the same groups

Case reportRadiotherapy and chemotherapy for oncological diseases &#8211; unappreciated risk factors for coronary artery disease? Acute coronary syndrome in 3 women after radiotherapy and chemotherapy &#8211; case reports

Chest irradiation and chemotherapy may lead to precocious coronary artery disease due to accelerated atherosclerosis or fibrointimal hyperplasia. Three cases of women (43, 50, and 53 years old) without typical risk factors for cardiac disease admitted to hospital due to acute coronary syndrome are described. Two of them had received chest irradiation and chemotherapy for Hodgkin&#8217;s disease in the past and the third had been treated with chemotherapy for breast cancer. They underwent emergency coronary angiography myocardial revascularisation with success (PCI treatment and CABG). Continued longitudinal screening of patients exposed to radiation and chemotherapy is needed to provide the best cardiology care