ISAR-REACT 5 — czy to badanie powinno zmienić praktykę kliniczną?

Prasugrel and ticagrelor are oral P2Y12 receptor inhibitors indicated by the European Society of Cardiology as the preferred antiplatelet therapy in patients with acute coronary syndrome (ACS). Despite the long-term and widespread presence of these agents in clinical practice, to date they have never been directly compared in a large, randomised clinical trial. ISAR-REACT 5 was the first such study, and it reported the superiority of prasugrel over ticagrelor. However, due to the arguable methodology of both the planning and the execution of this study, its results should be interpreted with caution, and they should not be considered sufficient to justify any changes to the current treatment strategies for patients with ACS.Prasugrel i tikagrelor są doustnymi inhibitorami receptora P2Y12 wskazywanymi w wytycznych Europejskiego Towarzystwa Kardiologicznego jako preferowane leczenie przeciwpłytkowe u pacjentów z ostrymi zespołami wieńcowymi (ACS). Mimo wieloletniej i coraz powszechniejszej obecności w praktyce klinicznej obu tych leków, dotychczas nigdy nie porównywano ich bezpośrednio w dużym, randomizowanym badaniu klinicznym. Pierwszym takim badaniem była próba kliniczna ISAR-REACT 5, w której wykazano wyższość prasugrelu nad tikagrelorem. Tym niemniej, ze względu na wątpliwości odnośnie do metodologii planowania i przeprowadzenia tej próby klinicznej, jej wyniki należy interpretować z ostrożnością i nie powinno się ich uznawać za wystarczające do wprowadzenia zmian w dotychczasowej strategii leczenia pacjentów z ACS

Radionuclides ^{137}Cs and ^{40}K in the soils of the Tatra National Park (TPN, Poland)

The paper presents the results of radioactivity determination of artificial 137Cs and natural 40K in soil samples taken from the Tatra Mountains in Poland (Tatra National Park – TPN). Soil samples were collected as the cores of 10 cm in diameter and 10 cm in depth. These cores were divided into 3 slices. It has been found that the content of 137Cs was the highest at the sites of the altitude over 1300 m a.s.l. The values of 137Cs concentration in the soils examined varied – from 55.8 Bqźkg–1 (dry mass) (417.8 Bqźm–2) for the Tomanowa Pass (1685 m a.s.l.) to 5111 Bqźkg–1 (dry mass) (8400 Bqźm–2) for the Krzyzne Pass (2112 m a.s.l.). In most cases, the values were lower than the average radiocaesium concentration established for Poland

Creative scientific dispute — different points of view on the protocol and execution of the ISAR-REACT 5 trial

Discordant interpretations of the results of clinical trials often drive scientific disputes. Our position concerning the protocol and performance of the ISAR-REACT 5 trial have been termed as false and groundless in the recently published article. We deeply disagree with this judgement and still maintain all our opinions expressed in the previous publications, without any exceptions. As demonstrated in multiple studies, prasugrel has excellent effectiveness and predictability. In our previous publications, it was not the drug itself that we put under criticism, but rather the quality of the trial assessing the drug. As a consequence of this critical approach, we stated that taking into account the serious limitations of the ISAR-REACT 5 trial, its results should be taken with cautiousness. To summarize, we remain open to further creative scientific dispute enriching both readers and authors

Doustne inhibitory płytkowego receptora P2Y12

Oral P2Y12 platelet inhibitors are base of the pharmacotherapy in patient with acute coronary syndrom. Effectiveness of clopidogrel, prasugrel or ticagrelor determine platelets inhibition and reduce the risk of embolic complications. This publication presents pharmacokinetic of different anitiplatelet drugs and factors which can affect on their effectiveness.Doustne leki przeciwpłytkowe są podstawą farmakoterapii stosowanej u chorego z rozpoznanym ostrym zespołem wieńcowym. Skuteczność działania klopidogrelu, prasugrelu czy tikagreloru warunkuje zabloko­wanie aktywności płytek krwi i zmniejszenie ryzyka powikłań zakrzepowo-zatorowych. W pracy przedsta­wiono mechanizm działania leków przeciwpłytkowych, a także czynniki wpływające na skuteczność terapii powyższymi lekami.

Czynniki wpływające na poziom motywacji do zaprzestania palenia tytoniu w grupie osób uzależnionych od nikotyny

Palenie tytoniu jest obecnie uznawane za jeden z największych problemów zdrowia publicznego w Europie. W realizacji profilaktyki chorób odtytoniowych edukację zdrowotną uznano za czołowe narzędzie. Natomiast podstawą w prowadzeniu działań edukacyjnych jest motywacja do zaprzestania palenia. Proces motywacji jest złożony i jak wskazują badania istnieje wiele czynników, które mogą na niego wpływać. Należą do nich między innymi: poczucie własnej skuteczności i poczucie koherencji. Poczucie koherencji, jaki i poczucie własnej skuteczności powinno stanowić bazę nowoczesnej psychoedukacji pacjentów uzależnionych od nikotyny. Oszacowanie we wstępnym etapie pracy z pacjentem jego zasobów pozwalałoby na zindywidualizowanie procesu edukacji i przygotowanie programu uwzględniającego jego potrzeby, co spowodowałoby większą skuteczność terapii. (Folia Cardiologica Excerpta 2010; 5, 2: 49-53

Diabetogenic effect of statins: a comprehensive review on the clinical relevance, underlying pathomechanisms and rationale for tailored statin therapy

Statins are potent hypolipidemic drugs effectively reducing low-density lipoprotein (LDL) cholesterol serum concentration, but also exerting a wide range of pleiotropic effects. In numerous clinical trials statins were proven to substantially decrease cardiovascular morbidity and mortality both in primary and secondary prevention. However, a growing body of evidence suggests that statins, although safe and generally well-tolerated, are associated with an increased occurrence of new-onset diabetes mellitus (DM). The aim of this review is to explore the relationship between statin therapy and new-onset DM, including its clinical relevance and underlying pathomechanisms, and to discuss the concept of tailored statin therapy. According to our recently published comprehensive network meta-analysis including 113,394 patients, the high-dose statin regimens were connected with an elevated risk of new-onset DM as compared with moderate-dose statin regimens and a gradient for the risk of new-onset DM across different types and doses of statins was demonstrated. There are multiple possible mechanisms explaining the diabetogenic effect of statins (e.g., decreased insulin secretion, induction of b-cell apoptosis, increased insulin resistance or compromised glucose transport into the cells). Statins are among the most widely used drugs worldwide and physicians should be aware of the fact that there is a risk of new-onset DM across different types and doses of statins. Selection of adequate statin that suits patient’s needs remains the challenge of hypolipidemic therapy. The identification of individuals who would benefit more from smaller doses and/or use of less diabetogenic compounds could help to optimize the treatment and reduce the number of patients developing DM. The non-pharmacological approach such as adequate physical activity, weight reduction and low fat diet should not be neglected either. These actions create a chance to decrease baseline LDL-cholesterol concentration and reduce the number of both cardiovascular and DM risk factors. All in all, statins with their exceptional cardiovascular benefits will undoubtedly defend their position of a cornerstone of cardiovascular prevention because profits derived from statin therapy far exceed the potential harms connected with statin-induced impairments of glucose metabolism

ISAR-REACT 5 — czy to badanie powinno zmienić praktykę kliniczną?

Prasugrel and ticagrelor are oral P2Y12 receptor inhibitors indicated by the European Society of Cardiology as the preferred antiplatelet therapy in patients with acute coronary syndromes (ACS). Despite the long-term and widespread presence of these agents in clinical practice, until now they have never been directly compared in a large, randomised clinical trial. ISAR-REACT 5 was the first such study, and it has reported the superiority of prasugrel over ticagrelor. However, due to the questionable methodology of both the planning and the execution of this study, its results should be interpreted with caution, and they should not be considered sufficient to justify any changes to the current treatment strategies for patients with ACS.Prasugrel i tikagrelor są doustnymi inhibitorami receptora P2Y12 wskazywanymi w wytycznych Europejskiego Towarzystwa Kardiologicznego jako preferowane leczenie przeciwpłytkowe u pacjentów z ostrymi zespołami wieńcowymi (ACS). Mimo wieloletniej i coraz powszechniejszej obecności w praktyce klinicznej obu tych leków, dotychczas nigdy nie porównywano ich bezpośrednio w dużym, randomizowanym badaniu klinicznym. Pierwszym takim badaniem była próba kliniczna ISAR-REACT 5, w której wykazano wyższość prasugrelu nad tikagrelorem. Tym niemniej, ze względu na wątpliwości odnośnie do metodologii planowania i przeprowadzenia tej próby klinicznej, jej wyniki należy interpretować z ostrożnością i nie powinno się ich uznawać za wystarczające do wprowadzenia zmian w dotychczasowej strategii leczenia pacjentów z ACS

75-year-old man with lung cancer obscured by an implantable cardioverter-defibrillator — case report

We present a case of a 75-year-old man, who underwent a scheduled implantable cardioverter-defibrillatorreoperation and has had a lung cancer found in a chest X-ray taken after the procedure, that wascompletely obscured by the previous device

Influence of deep-freezing on the autofluorescent properties of human plasma proteins

Background. Fluorescence-based techniques are powerful and valuable tools for studying biological materials. Fluorescence spectroscopy is one of these techniques which measures autofluorescence from a sample containing components such as proteins. The aim of this study was to evaluate the influence of deep freezing on spectroscopic properties of human plasma using fluorescence spectroscopy.Patients, materials and methods. The study group consisted of patients admitted to the Department of Cardiology and Internal Medicine at the University Hospital in Bydgoszcz, due to a preliminary diagnosis of acute coronary syndrome. The overall group comprised 27 patients. From each patient, 4 ml of blood was taken to obtainplasma that was used for further examination. In order to measure plasma spectroscopic properties, a Hitachi F-7000 spectrofluorimeter was used. The received results were analysed and evaluated with Origin 9.0 (OriginLab).Results. Spectroscopic analysis of human plasma before and after freezing allowed us to divide plasma samples into three different subgroups, depending on their fluorescent properties. The first subgroup consisted of plasma samples, which showed entirely differently in spectroscopic analysis after one week of deep-freezing. The second subgroup of plasma samples showed partial changes in the measurements of autofluorescence, and in the third subgroup freezing-resistant plasma samples were included.Conclusions. It seems that the process of deep-freezing could affect the autofluorescent properties of human plasma proteins. The explanation of the specific mechanisms responsible for the change of plasma fluorescent properties during the process of deep-freezing requires further elucidation