The Value of Urinary NGAL, KIM-1, and IL-18 Measurements in the Early Detection of Kidney Injury in Oncologic Patients Treated with Cisplatin-Based Chemotherapy.

Cisplatin is still a widely used anticancer drug characterized by significant nephrotoxicity. Acute kidney injury (AKI), diagnosed based on the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, has limitations, including a delayed increase in creatinine. We determined the usefulness of neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and interleukin-18 (IL-18) in diagnosing AKI according to the KDIGO criteria in patients treated with cisplatin. We recruited 21 subjects starting cisplatin-based chemotherapy (Cisplatin-based group) and 11 treated with carboplatin-based chemotherapy or 5-fluorouracil regimens (non-cisplatin-based group). Blood and urine samples were collected during four subsequent cycles of chemotherapy (68 and 38 cycles, respectively). AKI occurred in four patients in the cisplatin-based group (5.9% of 68 cisplatin-based chemotherapy cycles). Among them, three urinary markers were increased by over 100% in two cases, two in one case and one in another. A doubling of at least one investigated parameter was observed more frequently during cisplatin-based chemotherapy (80.3% vs. 52.8%; OR = 3.65, 95% CI: 1.49-8.90; p < 0.01). The doubling of at least one new urinary AKI marker was more common in patients receiving cisplatin and frequently was not associated with overt AKI. Thus, a subclinical kidney injury detected by these markers occurs more frequently than deterioration in kidney function stated with creatinine changes.

The assessment of effectiveness, tolerance, and patient satisfaction with the use of a new fixed-dose combination product, containing salmeterol and fluticasone propionate, Salflumix Easyhaler® in the treatment of asthma in the daily clinical practice.

BACKGROUND: The effectiveness of a fix-dose salmeterol/fluticasone combination therapy in asthma was previously shown for the original product. The study aim was to evaluate the clinical effectiveness and safety of a second entry DPI - dry powder inhaler (Salflumix Easyhaler) in patients with asthma in everyday clinical practice. PATIENTS AND METHODS: This multicenter Investigator-Initiated Study that enrolled 2,037 adult outpatients with asthma treated with Salflumix Easyhaler, was conducted by 220 pulmonologists across Poland. Asthma control was assessed during 3 visits with 6 ± 2 weeks intervals based on the Asthma Control Test (ACT). In addition, patient Satisfaction with Asthma Treatment Questionnaire (SATQ) and adherence and adverse events (AEs) were monitored. RESULTS: During the observation (86 ± 30 days) the percentage of patients with controlled asthma (ACT 20-25 pts) increased from 35.5% at the first visit to 86.5% at the third visit (p < 0.001). In the subgroup analysis, there were more patients not obtaining asthma control among patients that switched from the treatment with other devices than in naive ones. Global SATQ scores increased from 5.8 ± 0.7 to 6.2 ± 0.6 during the observation. Patients' satisfaction with the use of the Salflumix Easyhaler was high. Adherence exceeded 95%. Eight AEs were reported. CONCLUSIONS: Salflumix Easyhaler is highly effective and well-tolerated by naïve patients with asthma and those switching from another device. In general, patients show good compliance with medical product and are satisfied with the use of this new device, and not reporting difficulties and errors related to its' use. Their physicians' overall perception of Salflumix Easyhaler use is very positive.

The perception of e-learning during the SARS-CoV-2 pandemic by students of medical universities in Poland - a survey-based study.

BACKGROUND: In March 2020 lockdown due to the COVID-19 pandemic forced Polish Medical Universities to implement e-learning. The aim of the study was to evaluate the perception of e-learning by students of Medical Universities in Poland. MATERIAL AND METHODS: Survey was performed nationwide via the Internet from 30th November 2020 to 10th February 2021. Six hundred fifteen (615) medical students completed the survey. The study questionnaire included questions concerning sociodemographic data, perception of lecturers' effectiveness, assessment of stationary and online classes, changes in learning habits and restrictions on education, and advantages and disadvantages of e-learning. RESULTS: The respondents reported that 96.1% of lectures, 85.5% of seminars, and 40.0% of clinical classes were implemented by e-learning. The lectures conducted by e-learning were assessed as good and very good by 78.4% and seminars by 51.2% of respondents. While the clinical classes conducted by e-learning were assessed as bad and very bad by 62.9% of respondents. The most frequently indicated limitations of e-learning were the quality of the content and available materials (26.9%), restrictions in direct contact with the lecturer (19.6%), Internet connection (16.8%), and home conditions (13.8%). Only 4% of the students had to buy or retrofit computer equipment. Any other limitations were indicated by 9.7% of the respondents. CONCLUSIONS: Students were highly accepting of lectures and seminars conducted in the form of e-learning, but not laboratory and clinical classes. The main problems in e-learning are the quality of the classes conducted and the Internet connection. The students expect e-learning classes to be conducted in real-time, with direct, face-to-face contact with the lecturer.

Factors affecting the choice of budesonide in the therapy of croup, asthma and chronic obstructive pulmonary disease.

Introduction: Budesonide is one of inhaled corticosteroids with an established position in the therapy of croup, bronchial asthma and chronic obstructive pulmonary disease (COPD). Aim: To assess factors affecting the choice of budesonide in the therapy of croup, asthma and COPD by specialists and general practitioners in daily clinical practice. Material and methods: This multicentre, open-label, post-marketing survey was performed nation-wide with the participation of 1113 doctors and 100,980 patients treated with budesonide. The study questionnaire included questions about factors affecting the choice of budesonide and assessing the prescription pattern of the drug. Results: The doctors frequently declared use of budesonide in monotherapy in patients with croup, and in polytherapy in asthma and COPD (with salmeterol or formoterol and with formoterol, respectively). The most important factors affecting the choice of budesonide, as declared by doctors, were safety, efficacy, good personal experience with the use of this medication and recommendations of scientific associations. Budesonide in monotherapy was prescribed in 63.7%, 49.7%, and only 13.5% of patients with croup, asthma and COPD, respectively. The most important factors which determined the choice of this drug were safety (from 78.7% to 91.0%), efficacy (from 78.9% to 90.5%) and good personal experience of doctors (from 65.6% to 84.5%). Conclusions: Budesonide is still frequently chosen in the treatment of croup, asthma and COPD by Polish specialists and general practitioners because of its efficacy, safety and considerable experience in the application. Acquired clinical experience of physicians prevails over the issued recommendations of scientific societies regarding the use of budesonide in daily clinical practice.

A Stronger Effect of Body Mass Index and Waist Circumference on the Prevalence of Uncontrolled Hypertension among Caucasian Men than Women.

BACKGROUND: Gender-related differences in fat distribution may affect blood pressure (BP) control in hypertensive subjects. The aim of the study was to assess how body mass (BM), BMI, and waist circumference (WC) influence the effectiveness of antihypertension therapy in hypertensive men and women in daily clinical practice. PATIENTS AND METHODS: The observational study involved 12,289 adult hypertensive Caucasians (6,163 women) declaring regular use of antihypertensive drugs. BP control was scored based on the mean values of 2 attended office BP measurements. WC thresholds for visceral obesity were adopted from definitions of the International Diabetes Federation (≥94/80 cm for men/women) and National Cholesterol Education Program Adult Treatment Panel III (≥102/88 cm for men/women). Stepwise backward multivariable logistic regression was used to analyse correlates of the effectiveness of hypertension therapy. RESULTS: The predictive value of BMI ≥30 (for uncontrolled hypertension) was stronger than that of visceral obesity, regardless of the criteria used. In men, BP control rapidly deteriorated with BMI (odds ratio [OR] up to 8.58 [95% CI: 5.74-12.83]) and WC (OR up to 5.09 [3.84-6.74]), while in women, the association was more flattened (OR up to 3.63 [2.78-4.74] and 1.93 [1.59-2.35], respectively). However, the highest risk of uncontrolled BP occurred in women with BM ≥110 kg (OR = 10.47 [5.05-21.71]) and men with BM ≥125 kg (OR = 9.66 [5.86-15.94]). CONCLUSIONS: (1) Obesity and visceral obesity limit the effectiveness of antihypertension therapy more in men than in women. (2) This phenomenon should be taken into account in the prescription of adequate doses of antihypertensive drugs.

Factors affecting vitamin D status in outpatients with abdominal aortic aneurysm and peripheral artery disease- a single centre study.

BACKGROUND AND AIMS: Vitamin D (VD) deficiency is considered an important risk factor for the development of atherosclerosis and aortic aneurysms. The deficiency is claimed to enhance degeneration and remodeling of collagen and elastin fibers in the artery wall, leading to its weakening and progressive dilatation. This study aimed to assess vitamin D status, in outpatients with abdominal aneurysms (AAA) and peripheral artery disease (PAD) not treated with VD, and factors affecting serum 25-OH-D levels. METHODS AND RESULTS: This cross-sectional study involved 59 outpatients with AAA and 150 with PAD. AAA was defined as local dilation of the aorta diameter >30 mm in imaging. None of the patients was prescribed VD containing medicines. Serum 25-OH, iPTH, phosphorus and calcium levels were assessed in all study participants. VD status was categorized according to commonly used cut-offs for serum 25-OH-D (<20 ng/mL - deficiency, <30 ng/mL -insufficiency). Serum 25-OH-D levels were similar in patient with AAA and PAD [1-3Q: 26.2 (18.8-37.6) vs 21.8 (15.9-31.4) ng/mL; p = 0.30], with deficiency noted in 25.4% with AAA and 41.8% with PAD (p < 0.05). Multiple regression analysis revealed that VD deficiency was explained by past stroke episodes [OR = 2.80 (95%CI: 1.22-6.41)]. Secondary hyperparathyroidism was diagnosed in 1.7% of patients with AAA and 1.9% with PAD. CONCLUSIONS: The frequency of VD deficiency in outpatient with AAA is not greater than in those with PAD. Past stroke episode is associated with an increased occurrence of VD deficiency in both outpatients with AAA and PAD other than sun exposure and diet.

Is there a difference in body size dissatisfaction between the patients with obesity seeking and not seeking treatment for obesity?

BACKGROUND: Various factors motivate people to undertake treatment for obesity. Among others they include health benefits, willingness to please others, and dissatisfaction with one's appearance. The present study aimed to assess body size dissatisfaction in patients with obesity seeking and not seeking treatment for obesity. METHODS: Two-hundred-sixteen adult subjects (154 women, 62 men) including 80 people with BMI ≥ 30 kg/m2 starting treatment for obesity (BMI 35.7 ± 5.3 kg/m2) and 136 volunteers with obesity (BMI 34.7 ± 4.3 kg/m2) not seeking treatment for obesity, were enrolled. Body size satisfaction was assessed using the Figure Rating Scale adapted by Stunkard. RESULTS: Patients with obesity starting obesity treatment had more often a high level of body size dissatisfaction than volunteers with obesity not seeking the treatment (p <  0.001). There was a significant difference in the distribution of body size dissatisfaction in women (p <  0.05), but not in men (p = 0.47). CONCLUSION: Patients with obesity, especially women, seeking obesity treatment more often represent a high level of body size dissatisfaction than volunteers with obesity not seeking treatment for obesity. This implies the need for public health campaigns to address negative attitudes or misconceptions about obesity and its treatment. Placing more attention and emphasis on body size dissatisfaction in more vulnerable women with obesity may help to define personal motivations and goals, strengthen the doctor-patient relationship and better adapt therapeutic strategies.

Therapeutic preferences and factors determining the use of inhaled corticosteroids with long-acting ß2-agonists in patients with asthma and chronic obstructive pulmonary disease.

INTRODUCTION: Inhaled corticosteroids (ICS) and long-acting ß2-agonists (LABA) are a part of standard therapy of bronchial asthma and chronic obstructive pulmonary disease (COPD). AIM: Assessment of the therapeutic preferences and factors determining the choice of polytherapy with ICS and LABA in patients with asthma and COPD in daily clinical practice. MATERIAL AND METHODS: This multicentre, open-label, post-marketing observational survey was performed nation-wide with the participation of 245 doctors and 13,800 patients with asthma or COPD on polytherapy with ICS and LABA. The study questionnaire included two parts: concerning doctors' preferences in the use of ICS and LABA and their prescription in patients as well as efficacy and tolerance of inhaled drugs during two consecutive visits. RESULTS: The study doctors frequently declared a choice of polytherapy with formoterol and fluticasone in patients with asthma and COPD. The most important factors supporting the choice of ICS and LABA, declared by doctors, were safety and efficacy. ICS and LABA polytherapy with formoterol and fluticasone was used in 71.0% of patients with asthma and 81.4% with COPD. The most important factors explaining the choice of this drug combination were safety (75.3% and 72.5%, respectively) and efficacy (75.2% and 71.9%, respectively). CONCLUSIONS: Formoterol and fluticasone polytherapy is frequently chosen by Polish physicians in the treatment of asthma and COPD due to its high efficacy and safety. In accordance with doctors' declaration, in the study group this therapy was characterized by the highest effectiveness and the best tolerance.

Renal resistive index and long-term outcome in patients with coronary artery disease.

BACKGROUND: The study aimed to evaluate the application of intra-renal Doppler flow indices for the prediction of major adverse cardiac and cerebrovascular events (MACCE) during 24-month follow-up in patients with coronary artery disease (CAD) subject to coronary angiography (CA). METHODS: This prospective study comprised 111 consecutive patients with stable and unstable CAD (68.5% men; median age 65 years), referred for CA. Ultrasonographic parameters of intra-renal blood flow in arcuate/interlobular arteries, including renal resistive index (RRI) and pulsatility index (RPI), were acquired directly before and 1 h after the procedure. Endpoint of MACCE (cardiovascular death, myocardial infarction, myocardial revascularization or stroke) were recorded during 24-month follow-up. RESULTS: MACCE occurred in 14 patients (12.6%). Patients with MACCE had more diffuse CAD reflected by Syntax score (23.6 vs.14.4 pts., p = 0.02), higher platelet level (242.4 vs. 207.2 × 1000/µl, p = 0.01), higher rate of left main CAD (42.9% vs.5.2%, p < 0.001) and left ventricular ejection fraction < 50% (50% vs.23.7%,p = 0.045). Patients with MACCE had higher pre-procedural (0.68 ± 0.06 vs. 0.62 ± 0.06, p < 0.001) and post-procedural RRI (0.72 ± 0.06 vs.0.66 ± 0.06, p = 0.01), but comparable RPI (p = 0.63 and p = 0.36, respectively). Cox proportional hazards model revealed that pre-procedural RRI (OR = 1.11 per 0.01; p = 0.02) and left main CAD (OR = 5.75, p = 0.002) were the only independent predictors of MACCE occurrence. Receiver operator characteristic curve analysis revealed that preprocedural RRI > 0.645 accurately predicted the composite endpoint (AUC = 0.78, p = 0.001) and identified patients with impaired 24-month prognosis according to Kaplan-Meier curve (log-rank p < 0.001). CONCLUSIONS: Increased pre-procedural RRI, together with left main CAD, are associated with worse 24-month prognosis in patients with CAD referred for CA.

Plasma sclerostin levels are associated with nutritional status and insulin resistance but not hormonal disturbances in women with polycystic ovary syndrome.

OBJECTIVE: The aim of this study was to evaluate the circulating sclerostin levels with nutritional status, insulin resistance and hormonal disturbances in women with polycystic ovary syndrome (PCOS). PATIENTS AND METHODS: The cross-sectional study involved 98 PCOS inpatients (20 normal weight, 17 overweight and 61 obese) with stable body mass. Body composition was assessed by bioimpedance method in addition to anthropometric measurements (body mass and height). Serum/plasma concentrations of glucose, insulin (with the calculation of homeostatic model assessment insulin resistance-HOMA-IR), estradiol, total testosterone, sex hormone-binding globulin (SHBG) and sclerostin were measured. Free androgen index (FAI) and estradiol/testosterone index were calculated. RESULTS: Plasma sclerostin levels were significantly higher in obese [0.61 (interquartile range 0.53-0.77) ng/mL] than in overweight [0.53 (0.49-0.57) ng/mL] and normal weight [0.49 (0.42-0.54) ng/mL] groups. Plasma sclerostin levels were significantly higher in the subgroup with insulin resistance [0.65 (interquartile range 0.53-0.77) vs. 0.52 (0.46-0.58) ng/mL; p < 0.001], while similar concentrations were observed in subgroups with FAI below and above median. Plasma sclerostin levels variability were explained by BMI (r = 0.40), the percentage of body fat (r = 0.40) and HOMA-IR values (r = 0.34) in multivariable models. CONCLUSIONS: Circulating sclerostin levels in women with PCOS are related to nutritional status and insulin resistance, but not to sex hormone disturbances.

Could KIM-1 and NGAL levels predict acute kidney injury after paracentesis? - preliminary study.

BACKGROUND: Kidney dysfunction is a common complication in patients with severe liver cirrhosis. There is a need for discovery and validation of novel biomarkers for earlier AKI detection. The aim of this study was to determine if tubular injury markers: NGAL and KIM-1 could be helpful in the early diagnosis of AKI in patients undergoing therapeutic paracentesis. METHODS: This preliminary study included 24 adult patients diagnosed with liver cirrhosis who had been hospitalized due to massive ascites requiring paracentesis. Pre- and post-paracentesis plasma samples were taken from each patient and biomarkers were measured. RESULTS: Before paracentesis, the levels of serum and urinary NGAL were similar between patients and controls; while urinary KIM-1 was markedly increased in liver cirrhotic patients (0.76 vs. 0.24 ng/ml; respectively). Although urinary NGAL levels in AKI patients were 5-time greater than in non-AKI subgroup, the difference did not reach statistical significance (13.2 vs 1.5 pg/mL, p = 0.06). Serum NGAL level, post-procedure, was 3 times greater in AKI subgroup. CONCLUSION: Kidney injury markers, especially serum NGAL, may be useful for the early detection of AKI. However, further research is required to determine if biomarkers of kidney injury may help identify patients with cirrhosis who would most likely benefit from early AKI prevention and treatment.

The occurrence of depressive symptoms in obese subjects starting treatment and not seeking treatment for obesity.

INTRODUCTION: The psychological profile of obese people deciding to start obesity treatment may be different from those not choosing to seek the therapy. Previous studies have shown a higher incidence of depression in obese than in normal weight people. However, data are lacking concerning the occurrence of depressive symptoms and their severity in obese subjects who do or do not decide to start treatment for obesity. Therefore, the aim of this study was to evaluate the prevalence and severity of depressive symptoms among obese people starting treatment and not seeking treatment for obesity. MATERIALS AND METHODS: Enrolled subjects were 331 adults (241 women, 90 men), including 193 obese subjects starting treatment for obesity (46.8 ± 13.2 years, BMI 37.6 ± 5.5 kg/m2) and 138 obese volunteers never seeking treatment for obesity (44.3 ± 12.5 years, BMI 34.7 ± 4.3 kg/m2). Depression levels were determined using the Beck Depression Inventory (BDI). RESULTS: The level of depression was significantly higher among those starting treatment for obesity than those never seeking treatment for obesity (13.2 ± 9.2 vs. 9.5 ± 7.9 points; p < 0.001). This difference was statistically significant in women (14.4 ± 9.2 and 11.0 ± 8.2 points, respectively; p < 0.01), but not in men (7.2 ± 6.4 and 7.3 ± 7.1 points, respectively; p = 0.95). There were more women with moderate/severe depressive symptoms in the group starting treatment than in the group not seeking treatment for obesity (44.7 and 24.4%, respectively). No such difference was observed in men. CONCLUSIONS: Obese subjects, especially women, with depressive symptoms are more likely to start treatment for obesity. LEVEL OF EVIDENCE: Level III, case-control analytic study.

The herbal medicine containing of ivy leaf dry extract in the treatment of productive cough in children.

OBJECTIVE: The aim: The assessment of the therapeutic effects of the herbal medicine containing of ivy leaf dry extract administered twice a day in children with productive cough and their guardians' satisfaction with the use of this syrup. PATIENTS AND METHODS: Material and methods: A multicenter, observational survey was conducted by 268 doctors working in Primary Health Care. The survey was conducted during two routine, consecutive outpatient visits (including first supplemented retrospectively) resulting from the needs of therapy. RESULTS: Results: The study group consisted of 5162 patients treated for productive cough with the herbal medicine containing of ivy leaf dry extract administered twice a day. In 75.7%, productive cough was intense, in 61.6% it occurred at night, in 49.8% it was very common (several times per hour), and in 62.7% it affected daily activity. Most often the syrup containing of ivy leaf dry extract was used in doses twice a day for 2 ml or 4 ml. During observation the percentage of children with intensive, very common, night and affected daily activities cough decreased significantly. Very satisfied with a therapeutic effect of the preparation containing of ivy leaf dry extract administered twice a day were 68.2% of children guardians. CONCLUSION: Conclusions: The use of the herbal medicine containing of ivy leaf dry extract administered twice a day may be a good alternative to current therapeutic regimens in the treatment of productive cough in children. This recommendation is supported by effectiveness comparable to other medicines and a high level of satisfaction with its use by patients and guardians of chidren.

Pentraxin 3 as a marker of endothelial dysfunction in young women with polycystic ovary syndrome (PCOS).

One of the consequences of polycystic ovary syndrome (PCOS) is an increased risk of early development of cardiovascular diseases. Pentraxin-3 (PTX-3) is a new potential marker of endothelial dysfunction. The aim of the study was to assess PTX3 and other markers of endothelial dysfunction in PCOS women. The study enrolled 99 stable body mass PCOS women (17 normal weight, 21 overweight and 61 obese). Anthropometric measurements and serum/plasma levels of glucose, insulin, lipids, estradiol, testosterone, sex hormone binding globulin, 17-OH progesterone, free androgen index, pentraxin-3 (PTX3), soluble intercellular (sICAM-1) and vascular cell adhesion molecule 1 (sVCAM-1), endothelin-1 and total nitric oxide metabolites (tNO) concentrations were assessed. Groups were divided into tercile-subgroups according to PTX3 serum levels. Serum PTX3 tercile-subgroups significantly differed in respect to tNO, endothelin-1 and sVCAM-1, but not sICAM-1. The levels of tNO, endothelin-1 and sVCAM-1 were significantly decreased in the subgroup with the lowest PTX3 levels compared to both middle (tNO and endothelin 1) and upper tercile subgroups (all of them). There were significant positive correlations between log10(PTX3) and log10(tNO) (r = 0.34, p < .001), log10(endothelin-1) (r = 0.41, p < .001) as well as sVCAM-1 levels (r = 0.22, p < .05). Circulating PTX-3 levels seem to be a marker of endothelial dysfunction in PCOS women.

Osteoprotegerin Assessment Improves Prediction of Mortality in Stroke Patients.

BACKGROUND: Elevated circulating osteoprotegerin (OPG) level is associated with an increased risk of hospitalization for ischemic stroke and coronary artery disease. The aim of the present study was to analyze whether OPG assessment may improve the prediction of mortality in patients with stroke. PATIENTS AND METHODS: Serum OPG, fetuin A, 25-OH-D3, intact parathyroid hormone levels were assessed in serum samples which were left over after routine tests in a hospital laboratory. This assessment was conducted in 240 consecutive patients with acute ischemic stroke, admitted within 24hours after the onset of symptoms to the Stroke Unit. Mortality data were obtained from the local registry office. RESULTS: The mean OPG serum level was 14.6 ± 6.0pmol/L (range: 3.7-43.4). There were no significant differences in the OPG values between men and women (13.9 ± 5.0 versus 15.1 ± 6.7 pmol/L; P = .12). Therefore, tertiles were calculated for the whole group. During the follow-up, 85 (35.4%) patients died and 92 (38.3%) died or had recurrent stroke. OPG level appeared a significant predictors of death and composite end-point (death/recurrent stroke), in addition to the well-established once (age, atrial fibrillation, diabetes RANKIN at admission and discharge, severity of stroke). In multivariable stepwise backward analyses, the OPG level persisted as a significant and independent predictor of death (hazard ratio [HR] = 1.084 (95% confidence intervals: 1.036-1.134)] and composite and point (HR = 1.082 [1.037-1.129]). CONCLUSIONS: OPG level may be considered as a predictor of mortality in stroke patients.

Socio-economic determinants of vitamin D deficiency in the older Polish population: results from the PolSenior study.

OBJECTIVE: Numerous studies have reported an association between vitamin D (25-hydroxyvitamin D; 25(OH)D) deficiency and low economic status, lower educational level, drugs exposure, smoking and reduced physical activity. Our study analysed the association between sociodemographic factors and 25(OH)D status in Polish (Caucasian) seniors. DESIGN: Cross-sectional study (part of the PolSenior study). Serum 25(OH)D concentration was measured by a solid-phase ELISA method; a standardized questionnaire evaluated educational level, economic status, alcohol consumption, current or past cigarette smoking, physical activity, activities of daily living (ADL) and instrumental activities of daily living. SETTING: Community-dwelling randomly selected individuals aged 65 years or older, selected using three-stage stratified, proportional draw. SUBJECTS: Seniors (n 3472; 1658 women and 1814 men). RESULTS: Mean serum 25(OH)D concentration was 20·5 (sd 9·6) ng/ml. Values below the recommended level (30 ng/ml) were detected in 82·8 % of men and 90·4 % of women. Regression analysis revealed that the difference between sexes was associated with decreased walking activity in women, probably resulting in less sunlight exposure. There was a positive association between any disability in ADL and the presence of vitamin D deficiency/insufficiency. In the sex-adjusted analysis, older age, alcohol abstinence and lack of cycling and long-distance walking were explanatory variables for vitamin D deficiency. CONCLUSIONS: Vitamin D deficiency/insufficiency is frequent in the older Polish population and associated with functional disability and impaired mobility of seniors.

Dental status in the Polish senior population and its correlates-Results of the national survey PolSenior.

OBJECTIVE: The aim of the study was to assess dental status of Polish seniors having and wearing dentures in relation to demographic, socioeconomic and lifestyle factors. BACKGROUND: Tooth loss is associated with deterioration of general health status. The epidemiological data on dental status in Poland, including Polish seniors, are fragmented. MATERIALS AND METHODS: The study cohort consisted of 4524 randomly selected participants, aged 65 years and over, representative for Polish seniors. Demographic, socioeconomic, lifestyle factors and dental status were collected using standardised questionnaires. RESULTS: The prevalence of partial and complete edentulism in the Polish senior population was estimated at 45.7% and 47.1%, respectively. Fourteen point four per cent (14.4%) of complete edentulous participants and 31.1% with partial edentulism (1-19 natural teeth) did not have dentures, and one-twelfth of respondents having dentures were not wearing them. The independent correlates of complete edentulism were: female sex, advanced age, rural dwelling, lower education level, physical work in the past, smoking and diabetes. Male sex, age 90+, rural dwelling, type of work, dependence in activities of daily living and partial edentulism were independent correlates of not having dentures and denture disuse. Lower than average personal income was only significant for not having dentures. CONCLUSIONS: Complete edentulism is frequent among older Poles and affects almost 50% of them. It is associated with female sex, age, rural dwelling, poor economic status, smoking and diabetes. Rural dwelling and dependence of daily living are significant correlates of not having dentures and denture disuse.

N-Terminal Prohormone of Brain Natriuretic Peptide but not C-Terminal Pre-Pro Vasopressin (Copeptin) Level is Associated with the Response to Antihypertensive Therapy in Haemodialysis Patients.

BACKGROUND/AIMS: Volume overload, frequently clinically asymptomatic is considered as a causative factor limiting the effectiveness of antihypertensive therapy in haemodialysis (HD) patients. Therefore, the aim of this study was to assess plasma levels of N-terminal fragment of the prohormone brain natriuretic peptide (NT-proBNP) and a C-terminal portion of the precursor of vasopressin (CT-proAVP, copeptin), surrogate markers of volume overload in HD patients in relation to the number of antihypertensive drugs used in the hypertension treatment. METHODS: One hundred and fifty adult HD patients (92 males) were enrolled into this study. Clinical data concerning blood pressure (BP) measurements prior haemodialysis session and pharmacotherapy were collected from all patients. In addition to routine laboratory parameters, plasma levels of NT-proBNP and CT-proAVP were measured, and daily sodium and water consumption were estimated with a portion-size food frequency questionnaire. RESULTS: Among 145 (96.7%) hypertensive HD patients, 131 were receiving antihypertensive medication. Despite antihypertensive therapy, 31.0% had inadequate BP control. Plasma concentration of NT-proBNP was associated with systolic (R=0.19; p=0.02) but not diastolic BP values and with the number of received antihypertensive drugs (R=0.21; p=0.01). The highest NT-proBNP values were observed in patients receiving 3 or more antihypertensive drugs. In contrast, no significant correlation was found between plasma CT-proAVP concentrations and BP values as well as and the number of antihypertensive drugs. Receiver operator curve analysis showed that NT-proBNP values over 13,184 pg/mL predicted the use of at least 3 antihypertensive drugs in maximal doses in the therapy of hypertension, similar analyses performed for CT-proAVP showed much less specificity. CONCLUSIONS: 1. Increased levels of NT-proBNP seems to be a better biomarker of multidrug antihypertensive therapy requirement than CT-proAVP. 2. Whether estimation of NT-proBNP in these patients will be also better biomarker than copeptin in the prediction of cardiovascular complications related to hypertension needs further investigations.

Daytime decrease of prolactin levels is associated with PCOS regardless to nutritional status and other hormones levels.

OBJECTIVE: The aim of the study is to analyze daytime changes of prolactin level depending on nutritional status and polycystic ovary syndrome (PCOS). STUDY DESIGN: One hundred and fifteen (69 normal weight, 21 overweight and 25 obese) diagnosed with PCOS and 77 (37 normal weight, 18 overweight and 22 obese) women - Non-PCOS without concomitant diseases were enrolled. Body mass and height were measured and BMI was calculated. Serum concentrations of FSH, LH, E2, testosterone, TSH and PRL were determined morning 6.00 a.m. after wake. Second measurement of PRL was performed at 4 p.m. RESULTS: The daytime decrease of prolactin level was higher in PCOS than in Non-PCOS group regardless of nutritional status (normal weight 35.8 ± 26.0 vs. 24.3 ± 15.3 ng/mL; overweight 28.5 ± 25.4 vs. 17.5 ± 8.8 ng/mL and obese 23.2 ± 21.1 vs. 18.4 ± 11.6 ng/ml, respectively). However, in both PCOS and Non-PCOS daytime changes of prolactin level were higher in normal weight than overweight and obese women (35.8 ± 26.0 vs. 28.5 ± 25.4 vs. 23.2 ± 21.1 ng/mL and 24.3 ± 15.3 vs. 17.5 ± 8.8 vs. 18.4 ± 11.6 ng/mL, respectively). The multivariate regression analysis revealed that the daytime changes of prolactin level are proportional to TSH concentration and coexistence of PCOS as well as inversely relative to BMI. CONCLUSIONS: In conclusions, our results suggest that overweight and obesity decreased morning PRL level and impaired its daytime decrease, but coexistence of PCOS enlarged its.

Personality type influence the gestational weight gain.

Pregnancy is frequently followed by the development of obesity. Aside from psychological factors, hormonal changes influence weight gain in pregnant women. We attempted to assess the potential association between personality type and the extent of gestational weight gain. The study group involved 773 women after term delivery (age 26.3 ± 3.9 years, body mass before pregnancy 61.2 ± 11.1 kg). Weight gain during pregnancy was calculated by using self-reported body mass prior to and during the 38th week of pregnancy. Personality type was assessed using the Polish version of the Framingham Type A Behavior Patterns Questionnaire (adapted by Juczynski). Two hundred forty-six (31.8%) study subjects represented type A personalities, 272 (35.2%) type B and 255 (33.0%) an indirect type. Gestational weight gain was related to the behavior patterns questionnaire score and age. In women <30 years with type A personality, the weight gain was higher than in women with type B behavior of the same age. In women >30, the gestational weight gain was larger for type B personalities. Type A personality and increased urgency in younger pregnant women increases the risk of developing obesity during pregnancy in women below 30 years old. A higher level of competitiveness demonstrates a risk factor of excessive weight gain during pregnancy regardless of age.