Publications by authors named "Wiesław Bryl"

28 Publications

  • Page 1 of 1

A Comparison Between the Therapeutic Effect of Metformin Alone versus a Combination Therapy with Insulin in Uncontrolled, Non-Adherence Patients with Type 2 Diabetes: Six Months Follow-Up.

Diabetes Metab Syndr Obes 2021 14;14:3243-3252. Epub 2021 Jul 14.

Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, Poznań, Poland.

Purpose: The study aimed to compare the metabolic effects of an intensive dose of metformin alone among non-adherence patients with type 2 diabetes versus in combination with insulin among adherence patients.

Methods: The prospective cohort study was carried out on a sample of 140 patients above 18 years old, divided into two groups. The first group (n=70) was recommended metformin monotherapy in an intensive dose of 2-3 g/day, whereas the second group (n=70) was prescribed metformin (1-2g/day) in combination with insulin. FPG, HbA1c, BMI, blood pressure, TC, TG, HDL-C, LDL-C, creatinine, and eGFR were measured for each patient at baseline and after a follow-up of 6 months of active treatment.

Results: After six months of active treatment using monotherapy with an intensive dose of metformin, only 11.43% of patients achieved the target levels of HBA1c below 7%. In the group of patients treated using a combination of metformin with insulin, after six months of active treatment, 45.72% achieved HBA1c levels below 7% (p<0.0001). Compared with an intensive dose of metformin alone, the combination of insulin and metformin was associated with improved glycemic control (change of fasting blood glucose: 2.49 mmol/l vs 1.30 mmol/l, p=0.0016). Metformin use alone, as compared with insulin, was associated with a significant increase in HDL-C (+0.03 mmol/l vs -0.14 mmol/l, p=0.0485). Increased baseline obesity and increased baseline glycemia were the factors related to the likelihood of failing to achieve the target levels for HbA1c.

Conclusion: Metformin proved to be more effective in controlling hyperglycemia when combined with insulin therapy. Our study shows how many health benefits loss patients who, despite systematic diabetes education, do not agree to change their treatment in the form of adding a second drug, including insulin.
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http://dx.doi.org/10.2147/DMSO.S317659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286717PMC
July 2021

Peripheral T-Cell Lymphoma Possibly Due to Unrecognized Celiac Disease in an Elderly Patient: A Case Report.

Medicina (Kaunas) 2021 May 11;57(5). Epub 2021 May 11.

Department of Internal Diseases, Metabolic Disorders and Hypertension, Poznań University of Medical Sciences, Szamarzewskiego 84, 60-569 Poznań, Poland.

Celiac disease (CD) is widely perceived as a childhood disorder. However, it has been demonstrated that 19-34% of new CD cases are diagnosed in patients over 60 years of age and lack the typical presentation. A 76-year-old female was admitted to the clinic due to a recurrent fever that had lasted over a year accompanied by progressive weakness, weight loss of about 10 kg, dehydration, and malnutrition. The patient had undergone resection of a fragment of the small intestine due to perforation and abscess 13 years previously (at which time no histopathological examinations were performed). During the current hospitalization, despite extensive laboratory, microbiological, and imaging tests, no specific diagnosis was made. Symptomatic treatment and empirical antibiotic therapy were conducted, but the patient died on the twenty-seventh day of hospitalization due to progressive respiratory failure. The autopsy revealed peripheral T-cell lymphoma in the mesentery of the small intestine, uterus, cecum, lung, and mediastinal lymph nodes. Based on the clinical picture, we believe that the lymphoma was induced by long-term, undiagnosed CD. Current knowledge allows us to see age-related differences in the manifestation of celiac disease and to be alert to the possible late-stage complications of the disease. The lack of awareness of how CD's symptoms vary with age may lead to misdiagnosis and serious consequences of delayed diagnosis, including death.
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http://dx.doi.org/10.3390/medicina57050471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8151776PMC
May 2021

Clinical Characteristics of Hypertensive Patients with Obstructive Sleep Apnoea Syndrome Developing Different Types of Left Ventricular Geometry.

Biomed Res Int 2021 23;2021:6631500. Epub 2021 Jan 23.

Department of Internal Medicine, Medical University of Lublin, Staszica 16, 20-081 Lublin, Poland.

Objective: The objective of the study was to compare polygraphic parameters and selected laboratory parameters in patients with obstructive sleep apnoea (OSA) who develop various types of left ventricular (LV) geometry. . The research covered 122 patients with obstructive sleep apnoea and coexisting effectively treated systemic hypertension (95 men, 27 women, average age: 54 ± 10.63). Overnight polygraphy, echocardiography, carotid artery ultrasonography, and laboratory measurements were performed. The patients were classified into four groups, depending on LV geometry. Group 1 comprised patients with normal LV geometry, group 2 included those with LV concentric remodelling. Group 3 and group 4 were patients with LV hypertrophy, concentric or eccentric, respectively.

Results: The most frequent type of LV geometry in the examined population was eccentric hypertrophy (36%). The highest average values of BMI and T-Ch were observed in the group of patients with concentric remodelling (group 2). The most severe respiratory disorders were found in the group of patients developing LV concentric hypertrophy (group 3); however, these differences were not statistically significant in comparison to other groups. Patients with LV eccentric hypertrophy had significantly decreased LV ejection fraction ( = 0.0008).

Conclusions: LV eccentric hypertrophy is the most frequent type of LV geometry in OSA patients. Patients with severe sleep-disordered breathing are more likely to develop concentric hypertrophy, while concentric remodelling occurs more frequently among OSA patients with other coexisting conditions, such as obesity or lipid-related disorders.
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http://dx.doi.org/10.1155/2021/6631500DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850832PMC
September 2021

Impact of patient knowledge on hypertension treatment adherence and efficacy: A single-centre study in Poland.

Int J Med Sci 2021 1;18(3):852-860. Epub 2021 Jan 1.

Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences. Szamarzewskiego 84, 60-569 Poznan, Poland.

Recent studies show that treatment of arterial hypertension is unsuccessful. This is due to the patients' insufficient knowledge of about the therapeutic methods and the consequences of not treating arterial hypertension. The aim of the study was to evaluate the patients' knowledge concerning therapeutic options, prophylaxis, and complications of arterial hypertension. The study also assessed the effect of such knowledge on hypertension treatment adherence and efficacy. The survey included 488 patients (250 female and 238 male), aged over 18 years, diagnosed with and treated in outpatient and inpatient settings at selected healthcare institutions in Poland. A custom-made questionnaire, based on references on this subject, was the key tool in the present study. Information about the course of the disease and evaluation of hypertension treatment efficacy was based on the patients' medical records. The study found that 54.7% of the subjects had good knowledge about arterial hypertension, 40.0% had average knowledge, and 5.3% had poor knowledge. The extent of knowledge about the disease was significantly dependent on the level of education and the place of receiving medical care (< 0.05). Good knowledge was significantly associated with controlled blood pressure, number of antihypertensive drugs used, frequency of hospitalization, as well as with medication adherence, and healthy lifestyle behaviours (< 0.05). More than half of the patients presented good knowledge but a large group still had poor knowledge, especially patients with a low level of education and with hypertension treated at a general practitioner's clinic. The results of our study clearly show that knowledge about arterial hypertension affects medication adherence and healthy lifestyle behaviours and improves hypertension treatment efficacy.
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http://dx.doi.org/10.7150/ijms.48139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7797540PMC
January 2021

Effect of Different Blood-Pressure-Lowering Regimens on the Blood Pressure Control among Hypertensive Patients Treated in Hospital Conditions.

Int J Hypertens 2020 21;2020:3097198. Epub 2020 Oct 21.

Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences, Poznań, Poland.

Background: Scientific references lack sufficient amount of data on analyses of the reasons for hospital admissions or assessment of efficacy of arterial hypertension treatment at hospitals.

Objectives: The aim of the study was to evaluate the efficacy of antihypertensive drug therapy on the blood pressure control among hospitalized hypertensive patients. . A cross-sectional retrospective study consisted of 204 patients aged 18-65 years admitted to the hospital due to hypertension between January 2018 and December 2018. The study was based on analysis of electronic records, obtained from the medical database of the selected healthcare facility.

Results: As a result of the treatment applied at the hospital, 65.19% of the patients achieved the desired degree of blood pressure normalization (≤130/80 mmHg). Vast majority of the patients during their stay at the ward would receive three or more hypertensive drugs (63.73%). The most frequently prescribed antihypertensive drug combinations included bitherapies such as diuretics + ACEI and ACEI + -blockers and tritherapy such as diuretics + -blockers and calcium channel antagonists and diuretics + ACEI and ARBs. The highest blood-pressure lowering effects were observed among patients receiving combination therapy of a ACEI, a diuretic, and a ARBs. Tritherapy induced a significant mean reduction of inpatients`s SBP compared with bitherapy (=0.0001).

Conclusion: During their hospital stay, vast majority of patients (65.19%) achieved normal values of blood pressure, mostly owing to combined treatment with several hypertensive drugs. Efficacy of the most frequently used combinations of hypertensive drugs in normalizing arterial pressure varies.
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http://dx.doi.org/10.1155/2020/3097198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7596508PMC
October 2020

Does metabolically healthy obesity exist? A 32-year-old man with BMI 78 kg/m2 - to treat or not to treat?

Endokrynol Pol 2020 ;71(3):281-282

Chair and Department of Treatment of Obesity, Metabolic Disorders, and Clinical Dietetics, Poznań University of Medical Sciences, Poznań, Poland.

Not required for Clinical Vignette.
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http://dx.doi.org/10.5603/EP.a2020.0022DOI Listing
June 2021

Atrial fibrillation and obesity: should doctors focus on this comorbidity?

Minerva Med 2019 Apr 11;110(2):175-176. Epub 2018 Oct 11.

Department of Treatment of Obesity, Metabolic Disorders and Clinical Dietetics, Poznan University of Medical Sciences, Poznan, Poland.

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http://dx.doi.org/10.23736/S0026-4806.18.05816-0DOI Listing
April 2019

Managing metastatic bone pain: New perspectives, different solutions.

Biomed Pharmacother 2017 Sep 21;93:1277-1284. Epub 2017 Jul 21.

Palliative Medicine In-Patient Unit, University Hospital of Lord's Transfiguration, Poznań University of Medical Sciences, Poland; Department of Palliative Medicine, Poznań University of Medical Sciences, Poland.

Bone metastases are the most frequent cause of cancer-induced bone pain (CIBP). Although palliative radiotherapy and pharmacotherapy conducted according to World Health Organization (WHO) analgesic ladder are the treatment of choice for CIBP reduction, these methods are not always successful, especially with regard to alleviation of incidental pain. Antiresorptive drugs (bisphosphonates) are able to inhibit bone destruction (loss), proliferation of cancer cells and angiogenesis, but their prolonged use may lead to a spectrum of adverse effects. In this paper, types of bone metastases, their complications, as well as diagnostic and therapeutic implications are presented. Moreover, the paper discusses presently used CIBP treatment methods and research directions for future methods, with special focus on bone metastases.
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http://dx.doi.org/10.1016/j.biopha.2017.07.023DOI Listing
September 2017

Where are you headed internal medicine?

Authors:
Wiesław Bryl

Pol Arch Med Wewn 2016 Nov 30;126(11):916-920. Epub 2016 Nov 30.

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http://dx.doi.org/10.20452/pamw.3673DOI Listing
November 2016

The impact of high‑density lipoprotein on oxidant-antioxidant balance in healthy elderly people.

Pol Arch Med Wewn 2016 09 20;126(10):731-738. Epub 2016 Sep 20.

INTRODUCTION    There is an inverse relationship between high‑density lipoprotein cholesterol (HDL-C) levels and the risk of atherosclerosis. OBJECTIVES    The aim of the present study was to assess the oxidant-antioxidant balance in elderly people with different concentrations of HDL-C. PATIENTS AND METHODS    A total of 541 people aged 60 years or older were examined, of whom 90 individuals with no acute or severe chronic disorders had their waist circumference, body mass index, percentage of body fat, and blood pressure measured. Fasting and 120‑minute glycemia was determined in an oral glucose tolerance test, following which 15 patients with type 2 diabetes were excluded. Fasting plasma levels of lipids, total antioxidant status, and thiobarbituric acid-reacting substances (TBARS), as well ast the activity of erythrocyte superoxide dismutase 1 (SOD‑1) were assessed. Based on HDL-C levels, participants were divided into the high HDL‑C group (≥40.0 mg/dl and ≥50.0 mg/dl for men and women, respectively; n = 50) and the low HDL‑C group (<40.0 mg/dl and <50.0 mg/dl for men and women, respectively; n = 25). RESULTS    The groups did not differ in terms of age, blood pressure, body mass index, percentage of body fat, and glucose concentration. The high HDL‑C group had lower waist circumference (P <0.02) and lower triglyceride concentrations (P <0.00001). Increased TBARS levels (P <0.0005) was observed in the low HDL‑C group. There were no differences in SOD‑1 activity and total antioxidant status between the groups. CONCLUSIONS    HDL-C levels, which are known to reflect the antiatherogenic activity of HDL, including antioxidant properties, may indicate increasing oxidative stress in healthy elderly individuals.
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http://dx.doi.org/10.20452/pamw.3559DOI Listing
September 2016

Compliance Among Adolescents with Arterial Hypertension.

Adv Clin Exp Med 2016 May-Jun;25(3):441-8

Department of Internal Diseases, Metabolic Disorders and Arterial Hypertension, Poznan University of Medical Sciences, Poland.

Background: The term "compliance" means the degree to which the patient's behavior, applying medication or certain lifestyle changes, is consistent with arrangements communicated to him by a doctor or other healthcare professional. Literature indicates that the degree of adherence to medical recommendations for hypertensive patients is unsatisfactory, making it the main cause of the low effectiveness of antihypertensive therapy.

Objectives: The aim of the study was to assess the compliance of adolescents in the field of pharmacological and non-pharmacological methods of hypertension treatment.

Material And Methods: The study included 62 patients (20 women, 42 men) diagnosed with hypertension and treated in specialist healthcare facilities. As a research tool, a questionnaire prepared on the basis of recent literature was used.

Results: The vast majority of respondents (72.7%) declared that they were regularly taking antihypertensive drugs. The proportion of patients regularly taking antihypertensive drugs was higher in patients treated with monotherapy than with polytherapy (48.5% vs. 24.2%). Among the methods of non-pharmacological treatment of hypertension, the most accepted lifestyle change in the study population was smoking cessation (83.8% of respondents) and reduction of salt consumption (64.5% of respondents), and the least acceptable lifestyle change was maintaining proper body weight by eating a low calorie diet (30.6% of respondents).

Conclusions: Adolescents with hypertension adhere in varying degrees to medical recommendations related to the hypertension treatment. The available literature indicates that the currently effective way to improve cooperation with the patients is education.
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http://dx.doi.org/10.17219/acem/33838DOI Listing
December 2016

LIPID PROFILE OF POLISH PRIMARY CARE PATIENTS AGED 35-55 YEARS LIVING IN THE DISTRICT OF PLESZEW.

Acta Pol Pharm 2016 Mar-Apr;73(2):537-46

In Poland, more than half of the adult population suffers from lipid disorders. Among the 18 million Polish people with hypercholesterolemia, over 10.8 million are unaware of this problem. To estimate the lipid profile of selected primary care patients in the district of Pleszew (Western Poland), general practitioners (GPs) recruited 681 patients aged 35-55 years in 2011. Fasting serum lipids were evaluated. We found statistically significant differences in all lipid parameters between all younger (35-45 years) and older (46-55 years) patients, between all female and male subjects, between women and men ages 35-45 years; in total cholesterol (TC), LDL-cholesterol (LDL-C) and triglycerides (TG) between younger and older female population; in HDL-cholesterol (HDL-C) and TG between women and men ages 46-55 years. Dyslipidemia, both, newly detected and previously treated, was detected in 591 patients (86.8%): 322 females (84.3%) and 269 males (90.0%). The highest percentage of lipid disorders was found in males aged 46-55 years (91.9%) and the lowest among women aged 35-45 years (78.0%). Age and gender differences in the prevalence of dyslipidemia proved of statistical importance. Among 155 patients on lipid-lowering therapy, only 28 subjects (18.1%) reached the target value of serum lipids. The prevalence of lipid disorders among primary care patients aged 35-55 years in the district of Pleszew was significantly high, and it was proved that dyslipidemia is statistically prominent in males and older patients. Polish healthcare professionals should make more efforts to improve the detection and treatment of lipid disorders.
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June 2016

Aliskiren - an alternative to angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in the therapy of arterial hypertension.

Arch Med Sci 2014 Aug 30;10(4):830-6. Epub 2013 Apr 30.

Department of Cardiology-Intensive Therapy, Poznan University of Medical Sciences, Poland.

There has been enormous progress in antihypertensive therapy over the last few decades. However, the management of arterial hypertension is still insufficient and more efforts are needed to improve both non-pharmacological and pharmacological treatment of this widely prevalent disease. Renin-angiotensin-aldosterone system (RAAS) inhibition is crucial both for blood pressure (BP) control and for prevention of organ damage or its development in patients with hypertension. Angiotensin-converting enzyme inhibitors and/or sartans block RAAS incompletely. Aliskiren is one of the novel drugs that has been introduced to antihypertensive therapy recently. Up to now no trial has confirmed that aliskiren is efficacious in reducing cardiovascular events. Double RAAS blockade with aliskiren was not always safe. This review article presents the current view on the place of aliskiren in the therapy of arterial hypertension.
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http://dx.doi.org/10.5114/aoms.2013.34723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4175758PMC
August 2014

Economic aspects of hypertension treatment in Poland.

Arch Med Sci 2014 Jun 21;10(3):607-17. Epub 2013 Jan 21.

Institute of Psychology, Adam Mickiewicz University, Poznan, Poland.

Introduction: The aim of this study was to assess the costs associated with mild hypertension (HTN) in Poland and to compare the costs of 3-year ambulatory care for those diagnosed with mild HTN (group A) and those diagnosed with mild HTN and comorbidities (group B).

Material And Methods: The researchers undertook a retrospective study of a group of 120 patients treated for 3 years (2006-2008) (60%, n = 72 women and 40%, n = 48 men), taking into account the broadest possible social perspective. Medical and non-medical direct costs as well as indirect costs were calculated.

Results: The total costs of the 3-year pharmacotherapy in group A equalled 49,985.65 EUR, or 833.09 EUR per patient, whereas in group B the costs were twice as high: 105,691.55 EUR in total or 1,761.53 EUR per patient. Indirect costs for group A patients totalled 3,468.80 EUR (578.13 EUR per patient) and 4,579.20 EUR for group B patients (572.40 EUR per patient). Total direct costs (medical and non-medical) and indirect costs for group B patients were much higher, amounting to 130,228.14 EUR and 2,666.55 EUR per patient, which was double the costs in group A, where costs were 74,184.96 EUR and 1,756.73 EUR per patient.

Conclusions: The costs of HTN treatment in Poland are very high and are growing, like in other countries. Potential solutions include developing better patientdoctor communication to improve compliance, and increasing the chances of more effective and less expensive therapy by prescribing cheaper generic drugs, limiting polypharmacy and improving availability of novel therapeutic methods.
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http://dx.doi.org/10.5114/aoms.2013.32853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4107239PMC
June 2014

Analysis of direct costs of hypertension treatment among adolescents in Poland.

Acta Pol Pharm 2014 Jan-Feb;71(1):197-203

In adolescents, arterial hypertension (AH) is diagnosed much more frequently than previously thought--it affects 3.2% of the population aged 11-18. In Poland, at present, there are no cost analyses of treatment arterial hypertension among adolescents. The aim of the conducted studies was to analyze direct medical and non-medical costs in the time horizon of one calendar year (2010) of AH treatment in adolescents in Poland. A retrospective study from the societal perspective was based on data from 480 patients medical history cards obtained from the archives of the hospital. From this group, according to the criteria for inclusion in the study, a research group was selected consisting of 36 patients aged 16-18 years, with a diagnosed and treated hypertension. Analysis covered direct medical costs (costs of pharmacotherapy, doctors' visits and laboratory tests, hospitalization) and direct non-medical costs (cost of transport to the outpatient clinic). Average annual cost of hypertension treatment per patient was 89.96 Euro. The largest part of the structure of total costs related with hypertension treatment in adolescents in Poland were the costs of medical consultation with lab tests and diagnostic examinations--35.04% and pharmacotherapy costs--32.95%, with hospital stays rating somewhat lower with 19.12%, and the smallest part were the costs of the patient's transportation to the hypertension outpatient clinic--12.89%. Early identification of risk factors of such cardiovascular diseases as hypertension as early as in the developmental age, and their subsequent elimination, should be considered a good investment in the reduction of costs associated with hypertension treatment in adulthood.
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June 2014

Comparative studies on promotion of health and life style of hospital staff in Sweden and Poland.

Ann Agric Environ Med 2012 ;19(4):732-7

Chair of Social Medicine, Department of Hygiene, University of Medical Sciences, Poznan, Poland.

Introduction: Recently, an increase has been observed in the number of patients suffering from diseases which are the consequence of an anti-health life style; therefore it is necessary to undertake proper actions in this area, including those addressed to hospital staff.

Objectives: 1) Comparison of self-reported state of health and life style between hospital staff in Sweden and Poland, and the motivation of these employees to change the to-date life style for one that is more health promoting. 2) Presentation, based on Swedish experiences in the field of health promotion in hospitals, of the possibilities to implement these changes in Polish conditions.

Material And Method: The study covered the staff from the following hospitals: 1) hospitals in Östergötland County, Sweden, and 2) the Ludwik Perzyna Regional Polyclinical Hospital in Kalisz, Poland. The studies were conducted in parallel in Sweden and in Poland during the fourth quarter 2010. The research instrument was a questionnaire form.

Results: The following measures should be undertaken by the staff of Polish hospitals: an increase in the consumption of fruit and vegetables, physical activity, organization of workshops aimed at the shaping of skills of coping with stress and relieving stress, assistance in reducing body weight and increasing physical activity. Obligatory breaks at work should be introduced for the consumption of meals and intake of beverages, including water, promotion of fluid replacement would reduce fatigue. An obligatory lunchtime would allow each employee to consume a decent meal, and consequently have respite away from one's own work activities. In order to have a well-functioning staff an employer should, in his/her own interest, decrease potential sick absenteeism, provide incentives for motor activity, e.g. by the organization of groups, reduction of weekly working time on behalf of documented physical activity, or financial support for the purchase of tickets for various forms of physical exercises. Promotion of collective exercise, e.g. common nordic walking for 30 min. during lunch, competition in the largest number of steps made. Promotion of healthy nutrition by the preparation of recipes for meals, several exemplary healthy meals in the form of a healthy alternative breakfast. During this event, a basket of fruit is provided, instead of cakes and sweets.

Conclusions: 1) The life style of the staff of health care facilities is more health promoting in Sweden than in Poland. 2) It is possible to change the life style of employees of health care facilities into one that is more health promoting. Changes in this area have been made in Sweden with a great success; therefore, it is worthwhile implementing in Poland these Swedish experiences which may function also in Polish conditions. 3) The foundations of health promotion in enterprises have been known for a long time; however, considering the fact that the comparative studies show that these foundations are more advanced in Sweden, it is necessary that Polish employers devote more attention to this problem, and become interested in Swedish experiences in this area.
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July 2013

Blood antioxidant status, dysglycemia and obstructive sleep apnea.

Adv Exp Med Biol 2013 ;756:121-9

Department of Clinical Biochemistry and Laboratory Medicine, Poznan University of Medical Sciences, Poznan, Poland.

Obstructive sleep apnea (OSA) patients present increased cardiovascular morbidity and mortality. Oxidative stress is involved in OSA and cardiovascular pathology. The aim of the study was to assess oxidative stress markers in the blood of OSA males during oral glucose tolerance test (OGTT). The study involved OSA-suspected obese males (BMI ≥ 25 kg/m(2)) aged 35-64, with no acute or chronic disorders, appointed for polysomnography to diagnose OSA (AHI ≥ 5). The results of OGTT allowed to select prediabetic (Pre) subjects and normal glucose tolerance (N), excluding newly diagnosed diabetes. Blood was collected at 0 min (fasting) and 120 min of the test. Plasma glucose, total antioxidant status (TAS), thiobarbituric acid-reacting substances (TBARS), and activity of superoxide dismutase-1 (SOD) in erythrocytes, were determined at the two time points and the difference (D) between the 120 and 0 min time points was calculated for either oxidative stress variable (D-TAS, D-SOD and D-TBARS). Fasting serum insulin and lipids also were measured fasting. There were four groups of subjects, each consisting of 22 individuals N-OSA-neg(ative), N-OSA-pos(itive), Pre-OSA-neg and Pre-OSA-pos. The N-OSA-pos and Pre-OSA-pos subjects demonstrated decreased SOD-0 compared with OSA-negative groups. In N-OSA-neg and N-OSA-pos groups, the positive differences D-SOD and D-TAS were observed, while Pre-OSA subjects presented negative differences. In conclusion, prediabetic OSA patients may consume blood antioxidant factors to counter the effects of oxidative stress, more than individuals with normal glucose tolerance.
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http://dx.doi.org/10.1007/978-94-007-4549-0_16DOI Listing
December 2012

Dietary behaviours of adolescents from urban and rural areas in the district of Szamotuły--a preliminary study.

Ann Agric Environ Med 2012 ;19(1):103-7

Department of Internal Medicine, Metabolic Disorders and Arterial Hypertension, University of Medical Sciences, Poznan, Poland.

Introduction: Numerous factors and conditions affect the dietary behaviours of the young population. Urban-rural differences may also influence the lifestyle of adolescents, including diet.

Aim: To describe dietary behaviours of two young populations: living in urban or rural areas in the district of Szamotuły (a city with a population of 19,000 inhabitants).

Material And Methods: 116 adolescents aged 15-17 years were included to this preliminary study and asked to answer questions concerning health and lifestyle.

Results: No statistically significant difference was detected in the number of meals eaten daily, and 3 meals a day was the most frequent answer (45.9% in the rural group and 32.7% in the urban group). About 41.0% of rural subjects and 50.9% of urban ones admitted that they ate fresh fruit and vegetables every day. There was no statistically significant difference in the medium consumption frequency of fresh fruit, vegetable, fish, sweets and salty snacks.

Conclusions: 1. Between rural and urban adolescents no statistically significant differences were observed in dietary behaviours concerning medium number of meals eaten daily, medium frequency of fresh fruit and vegetable consumption, medium monthly frequency of fish consumption, medium weekly frequency of consumption of sweets and salty snacks. 2. More than a half of the young rural dwellers preferred more salty meals in contrast to over 56% of urban youths who preferred less salty meals. Both urban and rural adolescents most often declared that eat sweets and salty snacks daily. 3. There is a great need to change the dietary habits of teenagers, especially in avoiding an over-intake of high fat and high energy products, in order to reduce the rising prevalence of obesity among adolescents.
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July 2012

The way of serum chromium utilization may contribute to cardiovascular risk factors in centrally obese persons.

Arch Med Sci 2011 Apr 17;7(2):257-63. Epub 2011 May 17.

Chair of Chemistry and Clinical Biochemistry, Department of Clinical Biochemistry and Laboratory Medicine, University of Medical Sciences, Poznan, Poland.

Introduction: Obesity-related disturbances are considered to be risk factors for cardiovascular disease (CVD). Chromium is shown to improve carbohydrate and lipid metabolism. Conflicting data on effects of chromium supplementation in humans are published. The aim of the study was to assess the concentrations of serum chromium during the 75-g oral glucose tolerance test (OGTT) in obese persons.

Material And Methods: Fourty-eight centrally obese Caucasians, apparently healthy, using neither special diet nor mineral supplementation, were enrolled in the study. During the OGTT, 0-min and 120-min concentrations of plasma glucose (G 0', G 120'), serum insulin (Ins 0', Ins 120') and chromium (Cr 0', Cr 120') were determined. Plasma lipids, apolipoproteins A and B, and serum uric acid were measured at 0 min only. For parameters assessed during the OGTT, the difference D = [(120' concentration) - (0' concentration)] was calculated. Contradictory tendencies of Cr 120' were observed; thus the difference of serum chromium concentrations, DCr = [(Cr 120') - (Cr 0')], was used to establish the positive DCr group with DCr > 0 (PosDCr: n= 24; 9 male/15 female) and the negative DCr group with DCr < 0 (NegDCr: n= 24; 8 male/16 female).

Results: The studied groups were comparable as far as their metabolic parameters are concerned, except higher G 120' (p= 0.043) and DG (p = 0.048), and lower Cr 120' (p < 0.000), which were observed in the NegDCr group. The NegDCr persons showed inverse correlations between Cr 0' and systolic and diastolic blood pressure.

Conclusions: We suggest that the studied centrally obese persons differed in chromium metabolism. In subjects "consuming" Cr during the OGTT, chromium status may be associated with increased risk for CVD.
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http://dx.doi.org/10.5114/aoms.2011.22076DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258713PMC
April 2011

Estimation of physical activity and prevalence of excessive body mass in rural and urban Polish adolescents.

Ann Agric Environ Med 2011 ;18(2):398-403

Department of Internal Medicine, Metabolic Disorders and Arterial Hypertension, University of Medical Sciences, Poznań, Poland.

Excessive body mass and sedentary lifestyle are well-known factors for cardiovascular risk, which when present in the young population may have significant health consequences, both in the short- and long-term. The aim of the study was to evaluate the prevalence of overweight, obesity, and sedentary lifestyle in two teenage populations living in an urban or rural area. An additional aim was to compare their physical activity. The study was designed and conducted in 2009. The study population consisted of 116 students aged 15-17 years - 61 males (52.7%) and 55 females (47.3%), randomly selected from public junior grammar schools and secondary schools in the Poznań Region. There were 61 respondents from a rural area - 32 males (52.5%) and 29 females (47.5%), whereas 55 teenagers lived in an urban area - 29 males (47.5%) and 26 females (47.3%). Students were asked to complete a questionnaire, which was especially prepared for the study and contained questions concerning health and lifestyle. A basic physical examination was carried out in all 116 students, including measurements of the anthropometric features. Calculations were performed using the statistical package STATISTICA (data analysis software system), Version. 8.0. When comparing these two populations, no statistically significant differences were detected in the ratio of weight-growth, with the exception of the fact that the urban youths had a larger hip circumference (97.1 v. 94.3 cm, p<0.05). In the group of urban students there were also significantly more subjects with excessive body weight (27.3% v. 24.6%, p<0.05), with a predominant proportion of obese students (60%). There were significantly more male obese individuals (66.7%). In the population of rural teenagers, obesity rate did not differ statistically significantly from the percentage of overweight (11.5% v. 13.1%, p>0.05), the problem of excessive weight affected both sexes in a similar proportion (25% boys and 24.1% girls, p>0.05). In this paper it is shown that there were differences concerning physical activity of teenagers living in urban and rural areas. Urban students much more often declared an active lifestyle (72.7% v.42.6%, p<0.05), used a variety of additional forms of activity (not counting compulsory physical education classes).
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May 2012

[Chronic intestinal ischemia--not rare cause of abdominal pains--case description].

Pol Merkur Lekarski 2007 Jul;23(133):52-4

Department of Internal Diseases, Metabolic Disturbances and Hypertension Medical, University of Poznań, Poland.

Chronic intestinal ischemia is a diagnostic problem for the physicians from internal department as well for the surgeons. The clinical manifestation of this disease is not clear and the symptoms are similar to many other disorders. This requires from the physician a wide knowledge and many-sided diagnostic process. The success depends also on the good cooperation between radiologist and vascular surgeon. The authors presents the case of 59-aged patient with occlusion of superior mesenteric artery. After the angioplasty there was a complete relief of ischemic symptoms.
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July 2007

[The influence of ACE-inhibitor on endothelin concentration and some metabolic parameters in young hypertensives].

Pol Merkur Lekarski 2006 Aug;21(122):174-5; discussion 176

Akademia Medyczna w Poznaniu, Katedra i Klinika Chorób Wewnetrznych, Zaburzeń Metabolicznych i Nadciśnienia Tetniczego.

Unlabelled: The aim of this study was to assess the influence of trandolapril on blood pressure and ET-1 plasma activity in young patients with essential mild-to-moderate hypertension.

Material And Methods: 19 persons with essential mild-to-moderate hypertension were enrolled into the study: the average age of this group was 17,6 +/- 1,4 years. The blood pressure and serum concentration of ET-1 in plasma were measured before enrolling and after 42 days of trandolapril (2 mg per day) therapy. The concentration of endothelin-1 was measured using RIA method.

Results: In the studied group, after trandolapril therapy SBP was reduced from 142.6 +/- 9,7 mmHg to 129.3 +/- 8,4 mmHg (p<0,003), DBP from 85.7 +/- 6,9 mmHg to 79.8 +/- 8,6 mmHg (p<0,01). The average serum concentration of endothelin-1 was: before therapy 9,33 +/- 1,9 fmol/ml and after therapy 8,96 +/- 2,2 fmol/ml (non-significant).

Conclusions: 1. Young hypertensives treated with trandolapril (ACEI) showed significant decrease of SBP and DBP 2. 6-weeks trandolapril therapy was associated with the reduction of serum concentration of ET-1, but without statistical significance.
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August 2006

[Expression of chemokine receptor CCR5 in patients with type 2 diabetes].

Pol Merkur Lekarski 2006 Feb;20(116):195-8

Akademia Medyczna w Poznaniu, Katedra i Klinika Chorób Wewngtrznych, Zaburzeń Metabolicznych i Nadciśnienia Tetniczego.

Unlabelled: Overexpression of chemokine receptors might contribute to the initiation of atherosclerosis, due to promotion of monocyte migration to the subendothelial space which is considered as an initiating mechanism in the natural history of atherosclerosis. The CCR5 receptor is one of the chemokine receptors present on peripheral T lymphocytes, monocytes and macrophages.

Objective: The aim of the study was to determine the expression of CCR5 receptor on peripheral blood mononuclear cells (PBMC) in patients with type 2 diabetes.

Material And Methods: 14 patients with type 2 diabetes and 6 healthy subjects as a control were included to the study. We evaluated the density of the CCR5 receptor on peripheral blood mononuclear cells by flow cytometric analysis by use of LSR Cytofluorograf System (Becton Dickinson Co.).

Results: There was significantly higher density of the CCR5 receptor on PMBC in diabetic subjects when compared to the controls.

Conclusions: (1) Patients with type 2 diabetes present overexpression of the CCR5 receptor on peripheral blood mononuclear cells. (2). Overexpression of the CCR5 receptor should be considered as a factor that promotes the development of atherosclerosis in diabetic patients.
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February 2006

[The role of adiponectin in pathogenesis of insulin resistance and metabolic syndrome].

Pol Merkur Lekarski 2005 Nov;19(113):723-6

Katedra i Klinika Chorób Wewnetrznych i Zaburzeń Metabolicznych Akademii Medycznej w Poznaniu.

Metabolic syndrome occurs in about 25% of the adult population in industrialised countries. The pathogenesis of this syndrome is associated with insulin resistance. There are growing evidence that proteins produced in adipose tissue can play a role in development of insulin resistance. One of them is adiponectin (APM1), that circulates in human plasma at high level (5-30 microg/ml). A reduction in APM1 expression is closely associated with insulin resistance in animal models and in studies in humans. APM1 correlates with typical features of metabolic syndrome: BMI, WHR, total cholesterol, HDL, LDL and triglyceride levels, glucose, insulin, degree of insulin resistance in hyperinsulinemic-euglycemic clamp, blood pressure, hyperuricemia. There are some hypotheses that in the future therapy with APM1 may play a role in reversing insulin resistance in many disorders.
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November 2005

[Assessment of blood pressure and endothelin-1 plasma concentration in young, hypertensive patients after treatment with angiotensin converting enzyme inhibitor].

Pol Merkur Lekarski 2005 May;18(107):524-6

Klinika Chorób Wewnetrznych, Zaburzeń Metabolicznych i Nadciśnienia Tetniczego Akademii Medycznej w Poznaniu.

Background: Endothelin (ET) is the strongest endogenic substance causing vasoconstriction. The aim of this study was to assess the influence of ACEI therapy on serum concentration of ET-1 plasma activity in young patients with essential mild-to-moderate hypertension.

Design And Methods: 19 persons with essential mild-to-moderate hypertension were enrolled into study (14 male and 5 female). The average age of this group was 17.6+/-1.4 years. The patients were untreated or there was a 7 day wash out period. The blood pressure and serum concentration of ET-1 plasma were measured before enrolling and after 6 weeks of trandolapril (2 mg per day) therapy. The concentration of endothelin-1 was measured using RIA methods.

Results: In analyzed group there was a significant both SBP and DBP lowering after the ACEI therapy. SBP was reduced from 142.6+/-9.7 to 129.3+/-8.4 mmHg (p<0.003), DBP from 85.7+/-6.9 to 79.8+/-8.6 mmHg (p<0.01). The average serum concentration of endothelin-1 was: before treatment 9.33+/-1.9 fmol/ml and after therapy 8.96+/-2.2 fmol/ml.

Conclusion: The treatment with ACEI drug (trandolapil) induced the significant decrease of SBP and DBP in young hypertensives. 6-weeks trandolapril therapy was associated with the reduction of serum concentration of ET-1, but not statistically significant.
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May 2005

[Hypotensive effectiveness of therapy combined enalapril and nitrendipine and influence on the quality of life].

Pol Merkur Lekarski 2005 Mar;18(105):287-90

Klinika Chorób Wewnetrznych, Zaburzeń Metabolicznych i Nadciśnienia Tetniczego Akademii Medycznej w Poznaniu.

Unlabelled: It has been proved that effectiveness of monotherapy in mild hypertension is about 50%; in the other half of patients the dose of previously used drug should be increased or combined therapy should be recommended. THE AIM OF THE STUDY was to compare treatment with angiotensin convertase enzyme inhibitor--ACE-I (enalapril 10 mg bid--group 1) to therapy with ACE-I combined with calcium antagonist (enalapril 5 mg bid + nitrendipine 20 mg qd--group 2).

Material And Methods: In a prospective, open, randomised crossover study we assessed 44 hypertensive subjects (17 women, 27 men), aged 35-69 years (mean age 48.6 years) with poorly controlled hypertension treated with enalapril 5 mg twice daily. Mean initial systolic blood pressure was 150.8 < or = 9.9 mmHg, diastolic 94.7 +/- 5.3 mmHg respectively. The influence of the treatment regimen on the quality of life (QoL) was estimated by a questionnaire.

Results: The effectiveness of both used procedures did not differ statistically--in both groups mean blood pressure reduction was similar (14/8 mmHg in 4 weeks), also percentage of patients with well controlled hypertension (about 50%) did not differ significantly. In the group with changes regimen from monotherapy to combined therapy the improvement of systolic blood pressure was found to be statistically significant (p<0.05); in the case of combined therapy replaced with monotherapy such an improvement was not observed. In the subgroup with the isolated systolic hypertension combined therapy was considerably more effective. The improvement of QoL was noted in both groups, mainly in the initial phase of the study.

Conclusion: In mild hypertension ACE-I and calcium antagonist combination is effective in blood pressure reduction and in the improvement of the quality of life. Nitrendipine in a dose 20 mg in an once daily regimen is a potent and safe hypotensive agent, particularly in isolated systolic hypertension.
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March 2005

[The effect of analysed hypotensive drugs on certain metabolic parameters].

Pol Arch Med Wewn 2003 Mar;109(3):237-42

Katedra i Klinika Chorób Wewnetrznych i Zaburzeń Metabolicznych w Poznaniu.

The aim of this study was to assess the influence of 3 hypotensive drugs on the metabolic disorders: dyslipidemia, insulin resistance, hyperuricemia. There were 39 patients aged 20-55, with mild-to-moderate essential hypertension. The patients with other serious diseases or treated earlier with cholesterol or uric acid lowering drugs were excluded. Patients were divided into 3 groups, each was treated during 8 weeks with one drug: gr 1--trandolapril (T), gr 2--felodipine ER (F), gr 3--rilmenidine (R). Glucose and insulin in oral glucose tolerance test, I/G proportion, serum lipids and uric acid were tested before and after therapy. The therapy did not influence lipid parameters: LDL, HDL, triglyceride. In the T group there could be observed a significant reduction of total cholesterol value. Examined drugs did not induce changes in serum carbohydrate. The significant reduction of serum uric acid could be observed only after F therapy. Analysed drugs are very useful in therapy of hypertension with metabolic disorders.
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March 2003

[Circadian rhythm and variability of blood pressure and target organ damage in essential hypertension].

Pol Arch Med Wewn 2002 Jul;108(1):625-31

Katedra i Klinika Chorób Wewnetrznych i Zaburzeń Metabolicznych AM w Poznaniu.

The aim of this study was to evaluate the influence of blood pressure variability and circadian rhythm on left ventricular mass and urinary albumin excretion rate (UAE) in patients with essential hypertension. 82 untreated patients (35 women and 47 men; mean age 41.1 +/- 13.7) were recruited to this study. Mean office blood pressure at entry was 152/97 mmHg. Ambulatory blood pressure monitoring (ABPM) was performed using an Medilog ABP recorder (Oxford). Blood pressure variability was estimated as the standard deviation (SD) of systolic and diastolic ambulatory blood pressure. Urinary albumin excretion (UAE) was estimated by the radioimmunoassay during two separate days. Echocardiography was used to measure left ventricular mass and left ventricular mass index (LVMI). The median urinary albumin excretion for the whole group was 8.2 mg/day; in 18 patients (21.9%) microalbuminuria was present. Left ventricular mass index in a whole group was 109.1 g/m2; in 23 subjects (28.0%) left ventricular hypertrophy (LVH) was found. Patients with microalbuminuria as well as with left ventricular hypertrophy had higher office and 24 hour ambulatory systolic and diastolic blood pressure and higher systolic blood pressure variability. During ABPM 18 patients with absent nocturnal fall in blood pressure (non-dippers) were found; they did not display more frequent prevalence of target organ damage. Increased 24-hour blood pressure variability present in hypertensive subjects with both microalbuminuria and left ventricular hypertrophy may suggest that this phenomenon plays role in development of target organ damage.
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July 2002
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