Publications by authors named "Wojciech Myslinski"

34 Publications

The Assessment of Endothelial Dysfunction among OSA Patients after CPAP Treatment.

Medicina (Kaunas) 2021 Mar 25;57(4). Epub 2021 Mar 25.

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

: Microcirculation dysfunction is present in patients with obstructive sleep apnea (OSA). Intermittent hypoxia generates "oxidative stress", which contributes to chronic inflammation. The secretion of nitric oxide (NO), which is responsible for adequate regulation of the endothelium, is impaired due to a decrease in endothelial nitric oxide synthetase (eNOS) expression and an increase in endogenous eNOS inhibitors. Furthermore, nocturnal awakenings lead to the dysregulation of cortisol release and increased stimulation of the sympathetic nervous system. The non-invasive method of choice in OSA treatment is continuous positive airway pressure (CPAP). : PubMed, Scopus, and Google Scholar databases were searched, and only papers published in the last 15 years were subsequently analyzed. For this purpose, we searched for keywords in article titles or contents such as "obstructive sleep apnea", "microcirculation", and "CPAP". In our review, we only studied English articles that reported systemic reviews and meta-analyses, clinical studies, and case reports. : Endothelial dysfunction can be assessed by methods based on reactive hyperemia, such as flow-mediated dilation (FMD) measured by ultrasonography, laser-Doppler flowmetry (LDF), or capillaroscopy. In invasive techniques, intravenous administration of vasodilator substances takes place. Some surveys detected impaired microcirculation in OSA patients compared with healthy individuals. The level of dysfunction depended on the severity of OSA. CPAP treatment significantly improved endothelial function and microvascular blood flow and lowered the inflammatory mediator level. : The first-choice treatment-CPAP-reduces the number of apneas and hypopneas during the night, induces the reversal of hypopnea and the chronic inflammatory state, and enhances activation of the sympathetic nervous system. Changes are visible as improved blood flow in both macro- and microcirculation, increased arterial elasticity, and decreased stiffness. Thus, early implementation of adequate treatment could be essential to reduce high cardiovascular risk in patients with OSA.
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http://dx.doi.org/10.3390/medicina57040310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064446PMC
March 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
January 2021

Analysis of novel serum markers of fibrosis and angiogenesis in patients with alcoholic liver cirrhosis.

Ann Agric Environ Med 2020 Dec 2;27(4):568-573. Epub 2020 Oct 2.

Department of Internal Diseases and Hypertension, Institute of Rural Health, Lublin, Poland.

Introduction: Alcohol consumption causes acute and chronic liver injury. The clinical forms of alcohol liver disease (ALD) include steatosis, hepatitis, cirrhosis, and hepatocellular carcinoma (HCC) associated with liver cirrhosis.

Objective: The aim of the study was to determine the levels of novel markers of fibrogenesis and angiogenesis in patients with alcoholic liver cirrhosis. Serum levels of angiopoietin-like peptide 4 (ANGPTL-4), asialoglycoprotein receptor 1 (ASGP-R1), and S100 calcium-binding protein A8 (S100A8) were assessed. Levels of hyaluronic acid (Hyal) and collagen IV (Coll IV) werealso determined at various stages of alcoholic liver cirrhosis.

Material And Methods: The study group consisted of 72 patients with alcoholic liver cirrhosis, while the control group included 22 healthy subjects without a history of alcohol abuse. The degree of liver cirrhosis was evaluated according to the Pugh-Child criteria (Pugh-Child score). Based on thse scores, patients were assigned to one of three groups: Pugh-Child (P-Ch) A - 21 with stage A, P-Ch B - 23 with stage B and P-Ch C - 28 with stage C liver cirrhosis. Serum levels of markers were determined using ELISA.

Results: The study findings demonstrated higher levels of ANGPTL-4, ASGP-R1, S100A, hyaluronic acid and serum collagen IV in the group of patients with alcoholic liver cirrhosis, compared to the control group. Furthermore, their levels increased with the progression of alcoholic liver cirrhosis.

Conclusions: The biomarkers analysed in the study may be useful for diagnosis and prognosis in patients with alcoholic liver cirrhosis.
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http://dx.doi.org/10.26444/aaem/127621DOI Listing
December 2020

Ankle-Brachial Index as the Best Predictor of First Acute Coronary Syndrome in Patients with Treated Systemic Hypertension.

Biomed Res Int 2020 17;2020:6471098. Epub 2020 Jul 17.

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

Objective: The objective of our study was to evaluate the incidence of target organ damages (TOD) in patients with arterial hypertension and the first ever episode of myocardial infarction (N-STEMI or STEMI) and to determine which of the analyzed kinds of TOD had the highest predictive value for the assessment of the likelihood of acute coronary syndrome (ACS). . The study group consisted of 51 patients with treated systemic hypertension, suffering from the first episode of myocardial infarction (N-STEMI or STEMI), confirmed by coronary angiography and elevation of troponin. The control group consisted of 30 subjects with treated hypertension and no history of myocardial ischaemia. In all subjects' measurements of blood lipids, hsCRP and eGFR were measured. TOD, such as intima-media thickness (IMT), presence of atherosclerotic plaques, ankle-brachial index (ABI), and left ventricular hypertrophy, were assessed.

Results: Age, BMI, blood pressure, and time since diagnosis of hypertension did not differ between the study groups. There were no differences regarding blood lipids and eGFR, while hsCRP was significantly increased in the study group. The left ventricular mass index was similar in both groups. Patients with myocardial infarction had significantly increased IMT and decreased ABI. The statistical analysis revealed that only ABI was the most significant predictor of ACS in the study group.

Conclusion: Among several TOD, ABI seems to be the most valuable parameter in the prediction of ACS.
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http://dx.doi.org/10.1155/2020/6471098DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382730PMC
April 2021

Silica-Based Monolithic Columns as a Tool in HPLC-An Overview of Application in Analysis of Active Compounds in Biological Samples.

Molecules 2020 Jul 9;25(14). Epub 2020 Jul 9.

Chair and Department of Internal Diseases, Medical University of Lublin, 20-081 Lublin, Poland.

Monolithic fillings used in chromatography are of great interest among scientists since the first reports of their synthesis and use were published. In the 20 years since silica-based monolithic columns were introduced into the commercial market, numerous papers describing their chromatographical properties and utility in various branches of industry and scientific investigations were presented. This review is focused on possible applications of commercially available silica-based HPLC monolithic columns in the analysis of biological samples.
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http://dx.doi.org/10.3390/molecules25143149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397265PMC
July 2020

Obstructive sleep apnea may increase the risk of Alzheimer's disease.

PLoS One 2019 5;14(9):e0221255. Epub 2019 Sep 5.

Chair and Department of Internal Diseases, Medical University of Lublin, Lublin, Poland.

Objectives: Amyloid-β 1-40 (Aβ 1-40) and amyloid-β 1-42 (Aβ 1-42) are the proteins known to be involved in the pathogenesis of Alzheimer's disease (AD)-the most common cause of dementia in the elderly. Hypoxia is suspected to be one of conditions associated with Aβ plasma level increase. A common reason of hypoxia is obstructive sleep apnea (OSA), characterized by recurrent episodes of apnea.

Aim: The aim of the study was to evaluate plasma Aβ 1-40 and Aβ 1-42 concentrations in patients with OSA.

Methods: Patients with suspected OSA (n = 112) underwent polygraphic examinations Patients with confirmed OSA (n = 81) showed apnea/hypopnea index greater than or equal to 5. Mild and moderate form of the disease was defined when AHI was 5-30 (n = 38, OSA+), severe-when AHI was >30 (n = 43, OSA++). Individuals with AHI<5 (n = 31) served as control group (OSA-).

Results: Aβ 1-40 concentrations in OSA++ (191.1 pg/ml) group was significantly (p<0.05) higher compared with OSA- (76.9 pg/ml) and OSA+ (159.4 pg/ml) and correlated with selected parameters of hypoxemia severity. There were no differences in Aβ 1-42 concentration between the groups.

Conclusion: In patients with severe OSA Aβ 1-40 plasma concentrations are significantly higher compared with OSA- and OSA+ and seem to be related to hypoxia severity, which may indicate increased risk of AD development in this group of patients.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0221255PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728035PMC
March 2020

Spatial QRS-T angle in patients with newly diagnosed obstructive sleep apnea syndrome.

Adv Med Sci 2017 Sep 11;62(2):240-245. Epub 2017 May 11.

Department of Family Medicine, Medical University of Lublin, Lublin, Poland; Faculty of Medicine and Health Science, The Jan Kochanowski University, Kielce, Poland.

Purpose: The aim of the study was to assess the spatial QRS-T angle (QRS-TA) in a group of newly diagnosed and untreated adult patients with obstructive sleep apnea syndrome (OSAS) and to identify potential factors affecting this parameter.

Patients And Methods: The study group (PSG-confirmed OSAS) included 62 individuals, aged 51.7±10.3 years. The control group consisted of 25 individuals, aged 46.6±16.6 years with no sleep-disordered breathing. The diagnosis of OSAS and assessment of its severity was based on unattended all-night screening polysomnography. The spatial QRS-TA was reconstructed from 12-lead ECG using Kors' regression method.

Results: Significant differences of spatial QRS-TA values were found between patients with severe OSAS (36.9±18.9°) and the controls (20.3±13.4°; p<0.01) and between patients with mild or moderate OSAS (32.3±20.1°) and the controls (p=0.01). Statistically significant correlations were found between spatial QRS-TA and polysomnographic indices (i.e. AHI, AI, RDT and RDTI).

Conlusions: Spatial QRS-TA values are significantly higher in patients with OSAS than in controls, thus indicating increased heterogeneity of myocardial action potential. Further long-term prospective studies evaluating the prognostic value of spatial QRS-TA in OSAS patients are needed.
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http://dx.doi.org/10.1016/j.advms.2016.11.008DOI Listing
September 2017

Reliability of the Epworth Sleepiness Scale and the Berlin Questionnaire for screening obstructive sleep apnea syndrome in the context of the examination of candidates for drivers.

Med Pr 2016 Dec 13;67(6):721-728. Epub 2016 Dec 13.

Medical University of Lublin / Uniwersytet Medyczny w Lublinie, Lublin, Poland (Department of Family Medicine / Katedra i Zakład Medycyny Rodzinnej).

Background: The aim of the study has been to assess the usefulness of the Epworth Sleepiness Scale (ESS) and the Berlin Questionnaire (BQ) for obstructive sleep apnea syndrome (OSAS) screening. The capacity of both tests to discriminate between healthy individuals or with mild OSAS (apnea-hypopnea index (AHI) < 15/h) vs. patients with moderate or severe OSAS (AHI ≥ 15/h) was evaluated.

Material And Methods: The study encompassed 223 patients with a suspicion of the OSAS. The ESS and BQ were completed by patients unassisted. Screening polysomnography was performed using the Porti SleepDoc. The OSAS was diagnosed when AHI ≥ 15/h or AHI ≥ 5/h with simultaneous occurrence of clinical symptoms.

Results: The ESS score was found to be significantly higher in the study group compared to the control group (8.9±5.9 vs. 11.6±5.2 pt, p < 0.0001). Otherwise, there were no significant inter-group differences in the percentage of high-risk individuals according to the BQ (83.7% vs. 92.3%, p > 0.05). Sensitivity of the ESS and BQ was 53.2% and 93.1%, respectively while specificity was 58.8% and 16.2%, respectively. Poor correlation between the ESS score and AHI and apnea index were noticed (r = 0.22, p = 0.001 and r = 0.24, p < 0.001, respectively).

Conclusions: Considering its low sensitivity, the ESS should not be used as a screening test for the OSAS diagnosis amongst candidates for drivers. The BQ is characterised by high sensitivity for the OSAS diagnosis with AHI ≥ 15/h, however, due to low specificity, the questionnaire may increase the number of healthy individuals referred for needless diagnostic procedures. Med Pr 2016;67(6):721-728.
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http://dx.doi.org/10.13075/mp.5893.00494DOI Listing
December 2016

Evaluation of Fibrinolytic Inhibitors: Alpha-2-Antiplasmin and Plasminogen Activator Inhibitor 1 in Patients with Obstructive Sleep Apnoea.

PLoS One 2016 18;11(11):e0166725. Epub 2016 Nov 18.

Department of Internal Diseases, Medical University of Lublin, Lublin, Poland.

Obstructive sleep apnoea (OSA) induces thrombophilia and reduces fibrinolysis. Alpha-2-antiplasmin (a-2-AP) and plasminogen activator inhibitor 1 (PAI-1) are major inhibitors of the fibrinolytic system. Increased concentrations of these factors are associated with a higher risk of cardiovascular diseases. The aim of this study was to assess plasma a-2-AP and PAI-1 in patients with OSA and evaluate correlations with the polysomnographic record and selected risk factors of cardiovascular diseases. The study group comprised 45 patients with OSA, and the control group consisted of 19 patients who did not meet the diagnostic criteria of OSA. Plasma a-2-AP and PAI-1 concentrations were assessed by enzyme-linked immunosorbent assay (ELISA). In the study group, the median value of plasma a-2-AP was higher than that of the control group (157.34 vs. 11.89 pg/ml, respectively, P<0.0001). A-2-AP concentration increased proportionally to the severity of OSA. The concentration of a-2-AP was positively correlated with the apnoea-hypopnoea index (AHI), apnoea index (AI), respiratory disturbances time (RDT), and desaturaion index (DI), and negatively correlated with mean and minimal oxygen saturation (SpO2 mean, SpO2 min, respectively). The median value of PAI-1 was higher in the study group than the control group (12.55 vs. 5.40 ng/ml, respectively, P = 0.006) and increased along with OSA severity. PAI-1 concentration was positively correlated with AHI, AI, RDT, DI, and body mass index (BMI) and negatively correlated with SpO2 mean and SpO2 min. Higher plasma concentrations of a-2-AP and PAI-1 in patients with OSA indicated that these patients had increased prothrombotic activity. OSA increases the risk of cardiovascular complications as it enhances prothrombotic activity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0166725PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5115791PMC
June 2017

[Difficulty in diagnosis of primary hyperaldosteronism as the cause of resistant hypertension and severe hypokalemia--case report].

Pol Merkur Lekarski 2014 Nov;37(221):289-91

The most common endocrinological cause of secondary hypertension is primary hyperaldosteronism. Despite great progress in laboratory and imaging techniques, its identification is often difficult. We report the case of the 52-year-old man with resistant hypertension and severe hypokalemia. Renovascular hypertension, Cushing syndrome and pheochromocytoma were excluded as potential causes of drug-resistant hypertension in the presented case. Renal potassium excretion was significantly high. The results of plasma aldosterone concentration measured in supine position as well as in standing position were ambiguous. Computed tomography revealed abnormal round solid mass with a maximum diameter of 11 mm in the left adrenal. As there were not diagnostic results of laboratory research and ambiguous character of pathological structure in research computed tomography we have decided to carry adrenal cortex scintigraphy with iodomethyl-norcholesterol 131I. The result of this research was consistent with left adrenal scan of computed tomography and left adrenal adenoma has been confirmed. Normal blood pressure and normokalemia were restored after surgical treatment.
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November 2014

Are patients undergoing treatment of hyperlipidaemia with statins the best candidates for early cardiac rehabilitation?

Arch Med Sci 2011 Oct 8;7(5):756-9. Epub 2011 Nov 8.

Department of Cardiology, Cardinal Wyszynski's Hospital, Lublin Poland.

The role of statins in the primary and secondary prevention of cardiovascular events is well known. An important adverse event associated with statin treatment is myopathy; intensive physical effort in patients treated with statins increases the risk of muscle injury/myopathy. In this article we discuss the benefits and risks associated with statin treatment in patients undergoing cardiac rehabilitation after acute coronary syndromes and/or coronary revascularization procedures. In our opinion, the benefits of the secondary prevention of coronary heart disease achieved with statins seem to outweigh the hazards associated with statin therapy. The careful selection of patients for both treatment with statins and the gradual intensification of physical training in the course of cardiac rehabilitation appears to constitute an important element of the therapeutic approach.
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http://dx.doi.org/10.5114/aoms.2011.25548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258793PMC
October 2011

[Cardiac manifestation of Morgagni hernia--a case report].

Pol Merkur Lekarski 2010 Oct;29(172):255-8

Uniwersytet Medyczny w Lublinie, Katedra i Klinika Chorób Wewnetrznych.

The Morgagni hernia is a rare condition caused by the disturbances in the embryonal development of the diaphragm. The high pressure in the abdominal cavity during the persistent constipations or in pregnant women seems to be important predisposing factor apart from advanced age, obesity, vertebral column deformities and the connective tissue diseases. That is why the Morgagni hernia is very rarely diagnosed in children but usually in women in their fifties. We present the case report of our patent who was admitted to the Department of Internal Diseases for the diagnostics of lasting for 3-4 months weakness, chest pains and the episodes of palpitations. During her stay in our Department the routine chest X-ray examination was performed, that showed the unexpected result. The diagnosis of Morgagni hernia was afterwards confirmed in the computed tomography. Even though the risk of the acute abdominal conditions in the dislocated parts of gastro-intestinal tract our patient did not agree to proposed operation.
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October 2010

Relation between markers of inflammation and estradiol in older men.

Med Sci Monit 2010 Dec;16(12):CR593-7

Department of Internal Medicine, Medical University in Lublin, Lublin, Poland.

Background: Inflammation plays a key role in the development of atherosclerosis. Studies in women receiving estrogens show their proinflammatory effects. This study sought to determine relation between sex hormones and 2 inflammation markers: C-reactive protein and fibrinogen.

Material/methods: One hundred men of at least age 50 years were enrolled in the study. Plasma levels of total testosterone, estradiol, sex hormone binding globulin, high-sensitivity C-reactive protein, and fibrinogen were measured. Free estradiol and free testosterone were calculated.

Results: Estradiol and free estradiol levels were positively correlated with C-reactive protein and fibrinogen. In a subgroup analysis, this association persisted only in patients with stable coronary artery disease. No significant correlations were found between testosterone, free testosterone, sex hormone binding globulin, and markers of inflammation.

Conclusions: This study suggests that estradiol may have proinflammatory effects in older men with coronary artery disease.
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December 2010

[Pancytopenia after methotrexate treatment].

Wiad Lek 2009 ;62(2):115-8

Katedra i Klinika Chorób Wewnetrznych Uniwersytetu Medycznego w Lublinie, Samodzielny Szpital Kliniczny Nr 1 w Lublinie.

The use of methotrexate is associated with the risk of numerous, sometimes life-threatening, side effects. We describe a 76-year-old female patient treated with methotrexate (MTX) due to vertebral joint disease of unknown etiology. During the outpatient therapy, which was not conformed to doctor's recommendations, acute liver failure and symptoms of bone marrow damage developed. Despite intensive hospital treatment, the patient died.
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March 2010

[Serum creatinine level and eGFR as the indices of renal function in present-day clinical practice].

Przegl Lek 2010 ;67(7):491-5

Katedra i Klinika Chorób Wewnetrznych Uniwersytetu Medycznego w Lublinie.

The chronic kidney disease (CKD) is a polysymptomatic syndrome resulting from the reduction of active nephrons. It is estimated that the disease affects from 4.7-20% of adults. According to the actual knowledge, glomerular filtration rate (GFR) less than 60 ml/min/1.73 m2 is a significant risk factor for the cardiovascular diseases. The aim of our study was to assess the frequency of using the serum creatinine level and the estimated GFR (eGFR) as the indices of renal function in clinical practice. The study was performed amongst physicians working in non-academic departments of internal disease in the region of lubelskie voivodeships in 2008. An anonymous questionnaire of own composition consisting of 18 open and closed questions was used. The questions concerned the use of eGFR and serum creatinine level in everyday practice. 162 physicians were asked to fill the questionnaire, the percent of positive answers was 27.78% which is 45 questionnaires. The best parameter in evaluation of renal function, according to the asked physicians, was serum creatinine level (49% of all answers), eGFR (47%) and serum urea level or microalbuminuria (4%). Despite the actual recommendations, the serum creatinine level still remains the most popular routine parameter used to evaluate renal function. It seems that the knowledge concerning the diagnosing of CKD and the prophylaxis of its progression among physicians is insufficient. It concerns mainly physicians with no special training, working rather in profiled than in general medicine departments. Therefore, current educational programs concerning preventing and early diagnosis of CKD should be destinated mainly to these groups of physicians.
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October 2011

[Myopathy in the course of hypolipemic theraphy in patient undergoing early cardiac rehabilitation after the percutaneous coronary intervention--a case report].

Pol Merkur Lekarski 2009 Sep;27(159):226-8

Medical University of Lublin, Poland, Department of Internal Medicine.

The role of statins in primary and secondary prevention of cardiovascular incidents cannot be questioned. However, it is commonly known, that their use, especially in high doses, can cause side effects. Our study reports the case of female patient who because of an episode of unstable angina underwent the percutaneous coronary intervention (PCI) of right coronary artery (RCA), and afterwards received the hypolipemic treatment of simvastatin in the dose of 80 mg/day. After the PCI she participated in the programme of early sanatory cardiac rehabilitation. After some days of her stay she started to notice the generalized muscle pain, that she initially linked with the intensification of exercise. Two days after finishing the rehabilitation programme she was admitted to our Department with the symptoms of generalized muscle injury. Laboratory test revealed very high serum level of creatine kinase, myoglobin and transaminases. Data obtained from anamnesis and results of laboratory testing enabled to diagnose myopathy being the result of hypolipemic treatment with high dose of simvastatin. After the treatment we observed gradual regression of muscle pain, and in 12th day of the stay in our clinic the normalization of biochemical parameters was stated. Our patient reported she was not informed about the possible complications of undertaken treatment. This case report emphasizes the necessity to precisely inform the patients about the possible drugs side effects.
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September 2009

[Cognitive dysfunction in patients with chronic obstructive pulmonary disease].

Wiad Lek 2007 ;60(3-4):143-7

Katedry i Kliniki Chorób Wewnetrznych Akademii Medycznej.

The examination of cognitive function is not the part of the basic set of tests which is carried out in patients with chronic obstructive pulmonary disease (COPD). However there are some theoretical reports and sparse publications indicating the impairment of these functions among patients with COPD. These impairments are related to the patients with hypoxemia. In non-hypoxemic patients with COPD cognitive performance should be studied because of controversial reports. The influence of COPD on cognitive performance is partially reversible using oxygen therapy and/or physical activity which, in our opinion, is not appreciated enough. It seems that evaluation of cognitive performance with selected tests can be helpful in the assessment of severity of the disease. Moreover, it can be useful in estimation and prognostication of the self-dependence degree as well as the patients life span. The use of such methodological tools as corresponding tests analyzing cognitive performance in patients with COPD could lead to better care. It could also minimize the risk of transition of mild cognitive impairment into dementia which results in significant quality of life deterioration. It appears that patients with present impaired cognitive performance with or without recognized dementia should remain under special care providing adequate treatment. We assumed that due to properly managed treatment it may be possible to retain the process of increasing cognitive impairment what would effect in long-term self-reliance.
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September 2007

MinK gene polymorphism in the pathogenesis of lone atrial fibrillation.

Kardiol Pol 2006 Nov;64(11):1205-11; discussion 1212-3

Katedra i Klinika Chorób Wewnetrznych Akademii Medycznej im. prof. Feliksa Skubiszewskiego, Samodzielny Publiczny Szpital Kliniczny Nr 1, ul. Staszica 16, 20-081 Lublin.

Introduction: Atrial fibrillation (AF) is the most common type of complex arrhythmia found in everyday clinical practice. Lone AF is a particular form occurring in 2% to 31% of patients with confirmed AF. Genetic factors may underline this arrhythmia.

Aim: To determine the relationship between G38S polymorphism in the MinK gene and the incidence of lone AF, and to evaluate this polymorphism as a genetic marker of susceptibility to AF.

Methods: The study involved 69 patients with lone AF and 60 control healthy subjects. Both groups included patients aged up to 65 years without cardiovascular or thyroid disease. MinK genotype was determined with PCR-RFLP (polymerase chain reaction-restriction fragment length polymorphism). The MinK gene was present in two allelic forms: G and S.

Results: The MinK G allele was found significantly more often in patients with AF (62.32%) compared to control subjects (41.80%) (p=0.009). In the AF group GS occurred more frequently (55.07%) than GG (34.78%) and SS genotypes (10.14%). In a logistic regression model the presence of G variant was associated with increase of AF risk in the study population (OR 2.39; 95% CI 0.88-6.54; p=0.084). Presence of GG genotype was associated with significant, over 10-fold, increase of AF risk. Presence of S allele of the MinK gene met criteria of protective factor against AF in the study population.

Conclusions: 1. G38S polymorphism in the MinK gene seems to be associated with incidence of lone AF in the study population. 2. GG genotype carrier state may significantly relate to increased risk of AF in the study group. 3. G38S polymorphism in the MinK gene could be used as a genetic marker of risk of lone AF.
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November 2006

Cutaneous effects of the most commonly used antidepressant medication, the selective serotonin reuptake inhibitors.

J Am Acad Dermatol 2007 May 4;56(5):848-53. Epub 2006 Dec 4.

Department of Dermatology, New Jersey Medical School, USA.

Selective seritonin reuptake inhibitors (SSRIs) are widely used antidepressants that are often safer than alternatives, but may produce a variety of cutaneous reactions including spontaneous bruising, pruritus, urticaria, angioedema, erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis, erythema nodosum, alopecia, hypertrichosis, leukocytoclastic vasculitis, and an acneiform eruption. We review this category of medications and its side effects. Many cutaneous alterations seen in association with SSRIs can be serious, some even life threatening. Because there appears to be cross-reactions between SSRIs, even though they have different chemical structures, it is advisable to use another family of antidepressants if an SSRI is linked with a serious skin eruption.
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http://dx.doi.org/10.1016/j.jaad.2006.10.020DOI Listing
May 2007

Left ventricular geometry in patients with obstructive sleep apnea coexisting with treated systemic hypertension.

Respiration 2007 26;74(2):176-83. Epub 2006 Jan 26.

Department of Internal Medicine, University School of Medicine, Lublin, Poland.

Background: Left ventricular (LV) hypertrophy is a common consequence of systemic hypertension (SH) and obstructive sleep apnea (OSA). However, little is known about the degree of LV involvement in patients with OSA coexisting with treated SH.

Objectives: Our study was designed in order to assess the prevalence of distinct types of LV geometry in treated hypertensive OSA patients.

Methods:

Patients: 183 patients with treated SH were enrolled to the study. Group 1 consisted of 38 patients with newly-diagnosed OSA and ineffectively treated SH. The remaining 145 patients with effectively treated SH were divided into three groups: group 2 - 70 patients with newly-diagnosed OSA, group 3 - 31 patients with OSA treated with continuous positive airway pressure (CPAP), and group 4 - 44 patients without OSA. Overnight sleep studies and M-mode echocardiography were performed.

Results: LV mass index did not differ between the study groups. Mean values of LV end-diastolic diameter (LVED) were 55.4 +/- 6.8 mm in group 1 and 53.6 +/- 6.9 mm in group 2 and were significantly increased in comparison to subjects treated with CPAP and controls (49.8 +/- 6.8 mm and 50.1 +/- 64.7 mm, respectively; p = 0.001). LVED correlated positively with the apnea-hypopnea index and desaturation index. LV eccentric hypertrophy was the commonest type of LV geometry in newly-diagnosed OSA patients.

Conclusions: The major finding of our study is the predominance of LV eccentric hypertrophy in newly-diagnosed OSA patients. We suggest that a relatively moderate degree of LV involvement in hypertensive OSA patients may depend on the cardioprotective effect of concomitant antihypertensive therapy, ameliorating OSA-dependent neurohumoral abnormalities.
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http://dx.doi.org/10.1159/000091187DOI Listing
April 2007

[Cardiac structure and function in patients with obstructive sleep apnea syndrome and co-prevalent arterial hypertension. Influence of CPAP therapy].

Med Klin (Munich) 2006 Jan;101(1):1-8

Medizinische Klinik III, Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Berufsgenossenschaftliche Kliniken Bergmannsheil, Klinikum der Ruhr-Universität, Bochum.

Background And Purpose: 30% of patients with arterial hypertension (AH) are supposed to have a co-prevalent obstructive sleep apnea syndrome (OSAS). Hence, the influence of CPAP (continuous positive airway pressure) therapy on cardiac structure and function was investigated in medically treated patients with AH and co-prevalent OSAS.

Patients And Methods: In all patients AH was treated for at least 5 years. Matched pairs concerning anthropometric data, medical therapy and duration of AH, and severity of OSAS were investigated: 20 patients with untreated OSAS were compared to 20 patients with CPAP therapy for at least 6 months. Further cardiopulmonary diseases were excluded. Cardiac structure and function were assessed echocardiographically.

Results: Patients under CPAP therapy had significantly better diastolic left ventricular function, a lower left ventricular mass index, and significantly less frequent signs of left ventricular (eccentric) hypertrophy than patients with untreated OSAS. Furthermore, differences were significant concerning right ventricular wall thickness and mean pulmonary artery pressure.

Conclusion: CPAP therapy positively influences left and right cardial structure and function in addition to antihypertensive medication in patients with AH and co-prevalent OSAS.
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http://dx.doi.org/10.1007/s00063-006-1003-2DOI Listing
January 2006

Contemporary opinions on administration of inhaled glucocorticosteroids in the treatment of chronic obstructive pulmonary disease.

Ann Univ Mariae Curie Sklodowska Med 2004 ;59(2):491-7

Ward of Pulmonary Diseases and Phthisiology Independent Public Hospital named after John of God in Lublin.

The contemporary medicine is looking for new, more effective methods of treatment for patients suffering from chronic obstructive pulmonary disease (COPD), whose number is systematically increasing. It seems that main challenges involve improving treatment efficiency, preventing exacerbations and inhibiting the progression of the disease. The aim of this paper is to briefly present the contemporary knowledge of the application of inhaled glucocorticosteroid in COPD treatment, their effectiveness and side-effects. According to the present state of knowledge, inhaled glucocorticosteroid do not inhibit the neutrophil inflammation in COPD. However, they significantly restrict the inflammatory response in severe forms of the disease, which, practically, means decrease of exacerbation frequency, life quality improvement and mortality reduction in these patients. Inhaled glucocorticosteroids, just like systemic glucocorticosteroids, do have many side-effects, but they can be effectively prevented.
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September 2005

Pulmonary complications in amiodarone treatment.

Ann Univ Mariae Curie Sklodowska Med 2004 ;59(2):172-7

Ward of Pulmonary Diseases and Phthisiology Independent Public Hospital named after John of God in Lublin.

Amiodarone is a widely used antiarrhythmic drug, however, not without numerous side-effects. One of them is a potentially adverse reaction upon the respiratory system which can assume the form of acute respiratory failure, interstitial pneumonitis, parenchymal infiltrates, pleural effusion or bronchiolitis obliterans organizing pneumonia. For this reason prior to the onset of the long-term amiodarone therapy initial chest x-ray and spirometry should be made and in the course of the treatment spirometry and radiological monitoring should be carried out. Helpful in diagnosing the side-effects of amiodarone use in relation to the respiratory system could also be plethysmography, evaluation of the diffusing capacity, Gallium scintigraphy and cancer-associated serum antigen (CASA). While planning a long-term amiodarone therapy one should consider the risk factors of the development of pulmonary complications and the necessity to use this drug should be connected with the activities aiming at an early diagnosis of the respiratory system dysfunctions.
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September 2005

Hypertension, and not sex hormones or insulin resistance affects left ventricular mass in aging men.

Ann Univ Mariae Curie Sklodowska Med 2004 ;59(1):232-6

Department of Internal Medicine, Skubiszewski Medical University of Lublin.

Left ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity and mortality. The aim of the study was to find which factors influence left ventricular mass (LVM) and whether relationships exist between sex hormones: testosterone (T), estradiol (E2), sex hormone binding globulin (SHBG) and insulin resistance (HOMA-IR) and LVM. The study group consisted of 107 males at the age of over 50 years (mean 60.1 +/- 7.0). Positive significant correlations between LVM or left ventricle mass index (LVMI) and hypertension (0.23; p = 0.015 and 0.23; p = 0.019 respectively) as well as between LVM and body weight (0.38; p < 0.001) were observed. LVM and LVMI were higher in hypertensive than in normotensive men (279.9 +/- 82.2 vs. 243.4 +/- 70.3 g, p = 0.015 and 144.6 +/- 41.5 vs. 127.4 +/- 33.1 g/m2, p = 0.019 respectively). Multiple regression analysis showed LVM to be independently associated with hypertension and body weight. For LVMI such correlation was found only with hypertension. No relationships were observed between LVM/LVMI and insulin/insulin resistance.
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October 2005

Circadian rhythm of spectral indices of heart rate variability in healthy subjects.

J Electrocardiol 2005 Jul;38(3):239-43

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

Circadian pattern of heart rate variability spectral indices, including hourly, 24-hour, night, day, morning, and sex-adjusted measures of low frequency (LF), high frequency (HF), and LF/HF, was evaluated in healthy persons in 24-hour 3-lead electrocardiogram. HF showed circadian pattern with the greatest night values and LF/HF with the smallest night values. Peaks of hourly LF were found between 5 and 9 am and between 4 and 6 pm. The smallest LF was between 11 pm and 3 am. Hourly HF peaked between 11 pm and 5 am. The smallest HF was observed between midday and 2 pm. LF/HF peaked between 6 and 9 am as well as between 4 and 6 pm with the smallest values between midnight and 5 am. Sex adjustment was of no significance. In healthy subjects, HF and LF/HF have circadian pattern. Evaluation of all 5-minute intervals of 24-hour period seems to be a precise method of heart rate variability analysis.
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http://dx.doi.org/10.1016/j.jelectrocard.2005.01.012DOI Listing
July 2005

[Cardiovascular abnormalities in patients with obstructive sleep apnoea syndrome].

Wiad Lek 2005 ;58(1-2):78-83

Katedry i Kliniki Chorób Wewnetrznych Akademii Medycznej w Lublinie.

The activation of adrenergic and renin-angiotensin-aldosterone (RAA) systems observed in patients with obstructive sleep apnoea syndrome (OSA) strongly affects functional status of the cardiovascular system. In this paper we discuss the link between obstructive sleep apnoea syndrome and common cardiovascular diseases such as systemic and pulmonary hypertension, ischaemic heart disease, stroke, arrhythmia and ventricular hypertrophy. We also present the importance of early pharmacologic treatment in preventing cardiac hypertrophy and ventricular dysfunction in patients with obstructive sleep apnoea syndrome.
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August 2005

Diagnostic value of high resolution computed tomography in the assessment of nodular changes in pneumoconiosis in foundry workers in Lublin.

Ann Agric Environ Med 2004 ;11(2):279-84

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

The workers of an iron foundry were exposed to air pollution, which after some time of exposure results in lung fibrosis among some workers. The diagnosis of pneumoconiosis in workers of an iron foundry is based mainly on the radiological findings among workers exposed to the dust causing lung fibrosis. However, on radiograms many parenchymal structures overlap, which limits sensitivity and specificity to the method. Difficulties in accurate interpretation of conventional radiograms in silicosis also result from their relatively low resolution. The purpose of the present study was to assess the value and usefulness of high resolution computed tomography in the diagnostics of nodular changes in foundry workers' pneumoconiosis, compared to conventional radiography. The study group consisted of 64 iron foundry workers in whom silicosis had been recognized. The average age of the group was 51 years and the mean silica exposure time was 23 years. Chest radiograms with hard X-rays were taken at the maximal inspiration phase. For the HRCT examination the Siemens Somatom ART apparatus was used, equipped with a 512 x 512 pixels reconstruction matrix and a special programme for high resolution algorithm image reconstruction. In our material, consistency of results for conventional radiography and HRCT in revealing the presence of nodules was high. A statistically significant increase in detectability of intralobular nodules and peripheral nodules localized under the pleura was observed. The increase in detectability of cavernous, calcified nodules and those in the upper pulmonary fields obtained from computed tomography, however, was not statistically significant. High resolution computed tomography provides significant additional information in patients with foundry workers' pneumoconiosis.
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March 2005

Dihydrotestosterone treatment in men with coronary artery disease. II. Influence on myocardial ischemia and left ventricle.

Ann Univ Mariae Curie Sklodowska Med 2003 ;58(2):247-52

Department of Internal Medicine, Medical University of Lublin.

The effect of transdermal dihydrotestosterone on left ventricle mass and its systolic and diastolic function as well as on the results of treadmill stress test was assessed in eleven males with coronary artery disease. DHT treatment for 3 months resulted in significant decrease in isovolumetric relaxation time (0.150+/-0.37 s vs. 0.135+/-0.03 s; p < 0.05) indicating the improvement of left ventricle diastolic function. Left ventricle mass and systolic function indices remained unchanged. There was improvement in myocardial ischemia, time to 1 mm ST segment depression increased (p < 0.05) and ST/HR slope decreased (p < 0.01). Correlation coefficients between testosterone concentration at the beginning of the study and differences in selected parameters of ECG stress test were as follows: for T and increased total exercise time (r= -0.83, p=0.002), for T and increased maximum workload (r= -0.84, p=0.001), for T and increased time to 1 mm ST segment depression (r= -0.75, p=0.009) and for T and decreased ST/HR slope (r=0.68, p=0.02).
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October 2004

The influence of chronic obstructive pulmonary disease on the occurrence rate and intensification of osteoporosis.

Ann Univ Mariae Curie Sklodowska Med 2002 ;57(1):187-95

Department of Internal Diseases, Independent Public District Hospital, Zamość.

The aim of this study was the estimation of the relationship between osteopenia and osteoporosis and chronic obstructive pulmonary disease (COPD). The group under investigation consisted of 77 people suffering from chronic obstructive pulmonary disease in different stages of its development and control group. All the patients underwent spirometry carried out by means of abcPneumoRS system and bone densitometry carried out by means of Osteometer A/S using the DEXA method; the results were compared with those of the reference groups. Static and dynamic lung volumns were measured in all patients. By means of densitometry the mass, bone mineral density and T-score were determined in all patients' distal forearm. The research confirmed the relationship between the mass and density of bones and patients' age, sex, weight and body surface. Osteoporosis frequency rate was much higher among patients with chronic obstructive pulmonary disease, particularly women. The following relationship between the degree of disease progression and the mass and mineral density of the bones was observed: the more advanced airflow obstruction was, the lower osseous mass coefficients were. Forced expiratory volume during the first second and airflow obstruction reversibility rate determined by means of bronchodilator response also had a considerable influence on osseous mass coefficients.
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November 2003