Aging and the impact of global DNA methylation, telomere shortening, and total oxidative status on sarcopenia and frailty syndrome.

Aging is a biological event that influences many organs and systems. Both sarcopenia and frailty syndrome refer to geriatric conditions with overlapping phenotypes. Many mechanisms are involved in the aging process such as DNA methylation telomeres which are susceptible to oxidative stress, and inflammations which result in telomere shortening, leading to chromosomal instability. The study aimed to determine the associations between these processes, frailty and sarcopenia syndrome. Global DNA methylation was analyzed using the ELISA method. Telomere length was analyzed using qPCR. Total oxidative status (TOS) was analyzed using a colorimetric method. The present study revealed that the main factor affecting methylation, telomeres length and level of total oxidant stress was age.

Relationship between the Central and Regional Pulse Wave Velocity in the Assessment of Arterial Stiffness Depending on Gender in the Geriatric Population.

Artery stiffness is a risk factor for cardiovascular disease (CVD). The measurement of pulse wave velocity (PWV) between the carotid artery and the femoral artery (cfPWV) is considered the gold standard in the assessment of arterial stiffness. A relationship between cfPWV and regional PWV has not been established. The aim of this study was to evaluate the influence of gender on arterial stiffness measured centrally and regionally in the geriatric population. The central PWV was assessed by a SphygmoCor XCEL, and the regional PWV was assessed by a new device through the photoplethysmographic measurement of multi-site arterial pulse wave velocity (MPPT). The study group included 118 patients (35 males and 83 females; mean age 77.2 ± 8.1 years). Men were characterized by statistically significantly higher values of cfPWV than women (cfPWV 10.52 m/s vs. 9.36 m/s; p = 0.001). In the measurement of regional PWV values using MPPT, no such relationship was found. Gender groups did not statistically differ in the distribution of atherosclerosis risk factors. cfPWV appears to be more accurate than regional PWV in assessing arterial stiffness in the geriatric population.

Expression of Prostaglandin Genes and ß-Catenin in Whole Blood as Potential Markers of Muscle Degeneration.

Prostaglandin signaling pathways are closely related to inflammation, but also muscle regeneration and processes associated with frailty and sarcopenia, whereas ß-catenin (CTNNB1 gene) as a part of Wnt signaling is also involved in the differentiation of muscle cells and fibrosis. The present study analyzed the association between selected prostaglandin pathway genes and clinical parameters in patients with sarcopenia and frailty syndrome. The present study was conducted on patients with sarcopenia, frailty syndrome, and control older patients (N = 25). Additionally, two healthy controls at the age of 25-30 years (N = 51) and above 50 years old (N = 42) were included. The expression of the PTRGER4, PTGES2 (COX2), PTGS2, and CTNNB1 genes in whole blood was checked by the qPCR method. The serum cytokine levels (IL-10, TNFα, IFN-y, IL-1α, IL-1ß) in patients and controls were checked by the Q-Plex Human Cytokine Panel. The results showed a significant effect of age on PTGER4 gene expression (p = 0.01). A negative trend between the appendicular skeletal muscle mass parameter (ASSM) and the expression of PTGER4 has been noted (r = -0.224, p = 0.484). PTGES2 and PTGS2 expressions negatively correlated with creatine phosphokinase (r = -0.71, p = 0.009; r = -0.58, p = 0.047) and positively with the functional mobility test timed up and go scale (TUG) (r = 0.61, p = 0.04; r = 0.63, p = 0.032). In the older control group, a negative association between iron levels and the expression of PTGS2 (r = -0.47, p = 0.017) was observed. A similar tendency was noted in patients with sarcopenia (r = -0.112, p = 0.729). A negative trend between appendicular skeletal muscle mass (ASMM) and PTGER4 seems to confirm the impairment of muscle regeneration associated with sarcopenia. The expression of the studied genes revealed a trend in associations with the clinical picture of muscular dystrophy and weakening patients. Perhaps PTGS2 and PTGES2 is in opposition to the role of the PTGER4 receptor in muscle physiology. Nevertheless, further, including functional studies is needed.

Emotional and cognitive states of geriatric patients during the COVID-19 pandemic - an observational study.

Introduction: The authors of the study assessed the emotional and cognitive state of geriatric patients during the COVID-19 pandemic and tried to answer the question: were there any differences in this state in geriatric patients at different stages of the pandemic? Material and methods: The study included 518 patients of 60 years old and above of the Department of Geriatrics in Warsaw. To collect data, the following tools of psychological measurement were applied: the Mini-Mental State Examination scale and Geriatric Depression Scale. In order to test the differences in the means between the groups, a Chi-square test (with Yates's correction for continuity when the class size did not exceed 8 items) was used. For the comparison of the three groups, the Kruskal-Wallis (ANOVA) test was performed. Results: It was found that the majority of geriatric patients (73% of respondents) do not show symptoms of depressed mood. But there are statistically significant differences in the results of the patients' cognitive state tests depending on the time of examination. Patients examined before the pandemic tended to demonstrate a better cognitive state than patients at the beginning of the pandemic and in its later stages. Nevertheless, there are no significant differences in the cognitive functioning of patients examined at the beginning and later in the pandemic. Conclusions: The number of geriatric patients with symptoms of depression significantly increased when visits of relatives prohibition were introduced. However, the number of patients with depression returned to its previous level later in the pandemic.This phenomenon may indicate psychological adaptation to the situation. The presented results of observation suggest that the introduction of limitations is less important than the particular perception of one's situation and adaptation to that.

The 4DBODY system as a new tool for chest mobility assessment in patients with ankylosing spondylitis.

Introduction: Ankylosing spondylitis (AS) is a chronic inflammatory, progressive disease, which leads to deterioration of chest and spine mobility and decrease of physical capacity with abnormal chest movement patterns. We aimed to assess the usefulness of the 4DBODY technology for evaluation of the effectiveness of AS treatment. Material and methods: The 4DBODY technology was assessed on single AS patient with axial involvement. The patient was examined twice, before and after 14 days of rehabilitation. Physiotherapeutic and plethysmographic examinations were used, as well as angular measurement of spine curvatures and measurement of chest mobility. Chest activity measured using the 4DBODY system and the quality of movement were visualized. Results: There was observed an increase of chest mobility from 18 mm to 27.9 mm (up 55%) in the 4DBODY system measurement. The quality of the chest movement also improved, the required phases of inspiration were synchronized. The angular position of the spine has also changed. The chest expansion improved from 25 mm to 50 mm measured on the level of the fourth intercostal space and from 30 mm to 50 mm at the Th10 level. Inspiratory and expiratory muscle strength increased respectively from 80% to 93% and from 46% to 86% of the predicted values. Total airway resistance (Rtot) - increase from 59% to 67%, whereas functional residual capacity (FRC) and total lung capacity (TLC) did not change significantly. Conclusions: The new 4DBODY technology was found to be an effective method of examination and assessment of the effectiveness of rehabilitation of patients with AS.

Association between frailty and ischemic heart disease: a systematic review and meta-analysis.

BACKGROUND: Frailty is increasingly reported among older adults with cardiovascular diseases and it has been demonstrated to increase negative health outcomes and mortality. To date, no systematic review of the evidence is available regarding the association between frailty and ischemic heart disease (IHD). We performed a systematic review of literature and a meta-analysis to assess the association between frailty and IHD. METHODS: We selected all the studies that provided information on the association between frailty and IHD, regardless of the study setting, study design, or definition of IHD and frailty. PubMed, Web of Science and Embase were searched for relevant papers. Studies that adopted the Fried definition for frailty were included in the meta-analyses. For each measure of interest (proportions and estimates of associations), a meta-analysis was performed if at least three studies used the same definition of frailty. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. RESULTS: Thirty-seven studies were included. Of these, 22 adopted the Fried criteria to define frailty and provided estimates of prevalence and therefore they were included in meta-analyses. The pooled prevalence of IHD in frail individuals was 17% (95% Confidence Interval [95%CI] 11-23%) and the pooled prevalence of frailty in individuals with IHD was 19% (95% CI 15-24%). The prevalence of frailty among IHD patients ranged from 4 to 61%. Insufficient data were found to assess longitudinal association between frailty and IHD. CONCLUSIONS: Frailty is quite common in older persons with IHD. The identification of frailty among older adults with IHD should be considered relevant to provide individualized strategies of cardiovascular prevention and care. Further research should specifically explore the association between frailty and IHD and investigate the potential common biological ground.

European Collaborative and Interprofessional Capability Framework for Prevention and Management of Frailty-a consensus process supported by the Joint Action for Frailty Prevention (ADVANTAGE) and the European Geriatric Medicine Society (EuGMS).

BACKGROUND: Interprofessional collaborative practice (ICP) is currently recommended for the delivery of high-quality integrated care for older people. Frailty prevention and management are key elements to be tackled on a multi-professional level. AIM: This study aims to develop a consensus-based European multi-professional capability framework for frailty prevention and management. METHODS: Using a modified Delphi technique, a consensus-based framework of knowledge, skills and attitudes for all professions involved in the care pathway of older people was developed within two consultation rounds. The template for the process was derived from competency frameworks collected in a comprehensive approach from EU-funded projects of the European Commission (EC) supported best practice models for health workforce development. RESULTS: The agreed framework consists of 25 items structured in 4 domains of capabilities. Content covers the understanding about frailty, skills for screening and assessment as well as management procedures for every profession involved. The majority of items focused on interprofessional collaboration, communication and person-centred care planning. DISCUSSION: This framework facilitates clarification of professionals' roles and standardizes procedures for cross-sectional care processes. Despite a lack of evidence for educational interventions, health workforce development remains an important aspect of quality assurance in health care systems. CONCLUSIONS: The multi-professional capability framework for frailty prevention and management incorporated interprofessional collaborative practice, consistent with current recommendations by the World Health Organization, Science Advice for Policy by European Academies and the European Commission.

Osteosarcopenia in rheumatoid arthritis treated with glucocorticosteroids - essence, significance, consequences.

Rheumatoid arthritis (RA) is one of the most common rheumatic diseases, associated with cooccurrence of serious side effects. This study discusses the problems associated with chronic RA, well-known as osteoporosis, but also recently recognized as sarcopenia. Relationships between sarcopenia and rheumatic diseases are not yet fully understood. Co-occurrence of osteoporosis and sarcopenia, referred to as osteosarcopenia, is becoming increasingly important. The overlap of the effects of RA and osteosarcopenia and the adverse effects of glucocorticosteroids leads to progressive impairment of the musculoskeletal system, increasing the risk of falls, fractures, institutionalization and death, and it is a source of dramatic socioeconomic burden on society. Very limited options for effective treatment of developed osteosarcopenia, as well as the severity of complications caused by it, advocates for the need of broad education and raising public awareness, especially among health care workers, in order to implement the prevention of osteosarcopenia as early as possible.

[Pulse wave velocity - a useful tool in assessing the stiffness of the arteries]. / Pomiar predkosci fali tetna ­ uzyteczne narzedzie w ocenie sztywnosci tetnic.

Measurement of pulse wave velocity (PWV) is a simple and noninvasive way to assess stiffness of the arteries. PWV measurement can refer to both the aorta and peripheral arterial vessels. Currently, the most clinically significant is the measurement of PWV between the carotid artery and the femoral artery, which is defined as the speed of the aortic pulse wave. Numerous studies have demonstrated the significance of prognostic PWV aortic measurement as a recognized exponent of subclinical organ damage both among the general population as well as among patients with increased cardiovascular risk, examining patients in detail with hypertension, diabetes, chronic renal failure. The prognostic value of PWV aortic measurement was reflected in the guidelines of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). In clinical trials, the repeatability and reproducibility of PWV measurements were also evaluated, both parameters being considered satisfactory. The paper presents reports from studies on the significance of pulse wave velocity results in the prognosis assessment in different disease entities as well as in age groups.

Patient satisfaction as an element of healthcare quality - a single-center Polish survey.

OBJECTIVES: The aims of the study were to define the level of patient satisfaction with services provided by selected departments of the Institute, and to identify changes that should be introduced to the process of quality management in healthcare services. MATERIAL AND METHODS: A total of 455 patients from three departments of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, hospitalized between January 2016 and March 2018 were assessed retrospectively. Statistical analyses were conducted with the use of IBM SPSS Statistics 25 software. RESULTS: Patients at the Institute gave the highest rates to the courtesy and kindness of doctors and nurses (mean 4.77 and 4.73, respectively), the doctor's interest in a patient's well-being, and the nurses' dexterity in performing medical procedures (4.63 and 4.72, respectively) The lowest-rated were the quality of meals (mean 3.77) and the waiting time for hospital admission on an appointed day (mean 4.07). The study demonstrated statistically significant differences in evaluations made by female and male patients: women had worse opinions about maintenance of intimacy during medical procedures, whereas men gave lower ratings to the size of served meals. The level of satisfaction in all analyzed aspects increased with older age. However, a higher level of patient education correlated negatively with satisfaction from the waiting time for hospital admission on an appointed day, the ability to receive information about the disease and treatment process, cleanliness and accessibility of bathrooms and toilets, or the ability to easily move around the Institute. CONCLUSIONS: Accessibility of medical services, as well as attitudes and competences of the medical staff, are all key factors in ensuring quality care. The conditions of a hospital stay also shape the patients' opinions in a significant way. Therefore, taking into account the patients' opinions should become an important goal in the process of improving healthcare quality.

Mixed-etiology leg ulcers in a patient on long-term glucocorticoid therapy.

Chronic leg ulceration is a frequent condition in elderly patients. Chronic wounds that are nonresponsive to 3-month therapy affect approximately 6.5 million people in the United States with a prevalence of 1% and costs estimated at 25 billion dollars per year. Although the main causes are venous insufficiency, lower extremity arterial disease and diabetes, in many cases the etiology is multi-factorial. Approximately 20-23% of non-healing wounds that are refractory to vascular intervention have other etiologies including vasculitis, rheumatoid arthritis and Sjögren syndrome. Adverse drug interactions are the least commonly considered, especially those which involve disease-modifying anti-rheumatic drugs. The authors present a report on a female patient with reported Sjögren syndrome, multiple morbidities and non-healing lower limb ulceration that developed during treatment with methotrexate, and no significant improvement after discontinuation of the drug and after vascular surgery. Microvascular deterioration caused by beta-blockers was considered decisive. Calcium-blocker replacement brought complete healing in the follow-up.

Sarcopaenia and rheumatoid arthritis.

In October 2016 a new independent disease called sarcopaenia (according to ICD-10 classification) appeared. According to the recommendation of the European Working Group on Sarcopenia in Older People (EWGSOP), sarcopaenia is defined as abnormally low muscle mass plus low skeletal muscle strength or low physical performance. Sarcopaenia, as a primary disease, is mainly observed in older people, but it can also appear in younger adults in the course of many clinical chronic conditions. One of the most frequent chronic diseases associated with chronic inflammation and functional limitation of skeletal system is rheumatoid arthritis. In the present article, current knowledge on the epidemiology of sarcopaenia and its association with rheumatoid arthritis is presented.

[Overall principles of treatment in case of toxicological threats]. / Ogólne zasady postepowania w przypadku zagrozen toksykologicznych.

Toxins and venoms are silent weapons capable of killing people secretly. All around the world, there are a lot of such substances produced by bacteria, fungi, plants and animals. The threat to health and life, which are caused by toxins and venoms, meant that they are seen as a biological weapon. In the rescue proceedings with the victims the mechanism of toxin action is imported, because in some cases the antitoxins are known. However, in the most cases, the primary consideration is the symptomatic treatment. Conducted research on the usefulness of oxime and autofages in eliminating the effects of toxins are advanced, but not yet implemented into therapy. In each case the toxin action the victims must be evacuated to a safe location. It is also necessary to protect teams providing assistance in suitable protective clothing.

[Damage of the lungs after exposure to obscurant smoke - a case report]. / Uszkodzenie pluc po narazeniu na dzialanie swiecy dymnej - opis przypadku.

Firing smoke candle, on reaction of pyrotechnic mixture of zinc oxide and hexachloroethane, releases of white smoke, which can damage the pulmonary parenchyma. Presented case illustrates the effects of such an inhalation injury that has led to acute respiratory distress syndrome (ARDS). The use of mechanical ventilation and administration of antibiotics and corticosteroids give the possibility to obtain clinical improvement. The resulting changes in the lung parenchyma shown on imaging studies resulted in significant impairment of breathing.

[Detection of disease markers in the breath using optoelectronic methods]. / Wykrywanie markerów chorobowych w oddechu metodami optoelektronicznymi.

UNLABELLED: Great interest of scientific community is observed recently over non-invasive tests methods dedicated to diagnose disease states using biomarkers. The ability to detect these substances in the human breath can provide valuable information about disorder of biochemical processes in the body. Breath analysis is non-invasive, painless and can provide a quick answer about the existence of the disease. In addition, the sampling process is carried out comfortably for both the patient and the medical staff. AIM: The aim of the study was to present opportunity of application the optoelectronic methods for screening tests in medical diagnostics. The results of the researches carried out at the Institute of Experimental Physics, Department of Physics UW and at the Institute of Optoelectronics MUT are presented. MATERIALS AND METHODS: For the detection of methane and ammonia in breath the Multipass Spectroscopic Absorption Cells (MUPASS ) were used. In the case of nitric oxide and ethane observation, Cavity Enhanced Absorption Spectroscopy (CEAS) was applied. During the investigation modern tunable and sophisticated infrared radiation sources were used: single mode diode lasers (for CH4, NH3 detection), quantum cascade laser (NO sensing), and optical parametric generator (PG711/DFG) for ethane measurements. The investigations of developed sensors were conducted with use of reference samples of biomarkers, which were prepared with gas standards generator 491M from KIN-TEK company. RESULTS: Experiments showed that sensitivities of the sensors are suitable for human breath analyzing. In case of methane sensor, the detection limit (sensitivity) of ~ 0.1 ppm was obtained. This value is significantly lower than the upper limit of methane concentration in the breath of healthy humans (10 ppm). Therefore, our system well satisfies the requirements for diseases screening (e.g. intestines diseases ) and for methane monitoring in healthy human breath. Ammonia sensor is characterized with linear response in the concentration range higher than 1 ppm. The upper limit of ammonia concentration in healthy human breath is approx. 2 ppm, so this system is well suited for the determination of disease states (e.g. liver diseases). During the observation of nitrogen oxide the detection limit of 30 ppb was obtained. According to the ATS recommendation such NO detection limit is sufficient to monitor people's health state and for the detection of respiratory diseases like asthma or chronic bronchitis. For ethane detection with a wavelength of 3.348 microns the detection limit of 20 ppb was obtained. CONCLUSIONS: Developed sensors are characterized by high sensitivity (ppb-level) and high selectivity, simple and fast measurement procedure. Therefore, they can be applied as medical screening tools enabling biomarkers detection in exhaled air at the molecular level.

IGRA as a predictive factor of silent pulmonary changes in individuals following exposure to tuberculosis.

OBJECTIVES: We conducted a study on usefulness of the tuberculin skin test (TST) and the Quantiferon-TB Gold IT (QFT) tests as predictors of radiological changes after contact with tuberculosis. MATERIALS AND METHODS: The study group consisted of TB-exposed HCWs working in the Military Institute of Medicine (Warsaw, Poland). The usefulness of TST, QFT, and a combination of both tests was assessed for prediction of silent radiological findings. RESULTS: 83 previously TB-exposed participants were recruited. None of the participants had a history of active tuberculosis. Positive TST results were reported in 72 (86.8 %) participants, and positive QFTs were observed in 27 (32.5 %) cases. Chest radiographs revealed 23 findings specific for non-active tuberculosis in 18 (21.7 %) participants. The results of the QFTs were associated with the highest negative predictive value, positive predictive value, and positive likelihood ratio of silent chest X-ray findings suggestive of latent tuberculosis infection. Positive QFT was the only statistically significant variable that increases the odds ratio (OR-8.3) of the presence of typical of tuberculosis radiological changes in the lung. CONCLUSION: A positive QFT result in an individual with no TB history who was exposed to tuberculosis in the past is associated with a significantly higher risk of clinically silent parenchymal lesions in lungs suggestive of previous tuberculosis.

[Utility of point-of-care ultrasound in lung disease diagnosis]. / Przydatnosc point-of-care USG w diagnostyce chorób pluc.

A new method in the diagnostics of respiratory failure is lung ultrasound (LUS). The test assesses the pleural line and its related artefacts caused by the changing content of extravascular lung water which conditions the degree of lung aeration. Assessment of the movement of the pleural line and the related artefacts (A lines and B lines) enables diagnosis of respiratory failure and treatment monitoring. The advantage of LUS is the possibility of assessing lung function in real time, and the possibility of obtaining information about aeration of the examined part of lung parenchyma. In comparison to other imaging methods, ultrasound is characterized by a considerable specificity and sensitivity in diagnostics and differentiation of numerous diseases, such as pneumothorax, pneumonia, ARDS, and pulmonary edema.

Is geriatric medicine teaching homogeneous? The analysis of geriatric medicine courses at Polish undergraduate medical programmes.

PURPOSE: We aimed to analyse the characteristics of geriatric courses offered to undergraduate medical students in higher educational institutions (HEIs) in Poland. METHODS: We searched the official websites of the HEIs offering the medical degree programmes and directly contacted the dean's offices and HEIs representatives to retrieve the relevant information. The documents were analysed for course content, teaching methods, duration, and recommended texts. We also checked the obtained curricula for the reference to of the learning objectives related to geriatric medicine, selected from the currently endorsed Polish educational standards (ES) provided by the Ministry of Science and Higher Education. RESULTS: Geriatric medicine courses were obligatory at all included HEIs (n = 19), but the courses differed in structure and content. The courses varied in duration from 11 to 60 h and were primarily lecture based. Simulation was utilized at only one HEI and e-learning at two institutions. Out of 315 learning objectives, we acknowledged only 9 as geriatric. They were not always found in all curricula. Two HEIs included self-described learning objectives in their curricula. Across all HEIs, a total of 29 recommended texts (published between 1995 and 2021) were identified, including 2 English-language texts. CONCLUSION: Geriatric medicine was a mandatory subject for medical students of the included HEIs. However, there was a lack of uniformity in the offered courses. This leaves room for the development of a unified undergraduate geriatrics curriculum to effectively address diverse geriatric issues across Europe. The importance of this matter is highlighted by demographic trends and workforce challenges.

Is the association between pulse wave velocity and bone mineral density the same for men and women? - A systematic review and meta-analysis.

BACKGROUND: Brachial aortic Pulse Wave Velocity (baPWV) and bone mineral density (BMD) are important indicators of cardiovascular health and bone strength, respectively. However, the gender-specific association between baPWV and BMD remains unclear. The aim of our study is to evaluate the relationship between baPWV and BMD in men and women populations METHODS: A comprehensive search was conducted in electronic databases for relevant studies published between the 1th and 30rd of April 2023. Studies reporting the correlation between baPWV and BMD in both males and females were considered. A random-effects model was used to calculate pooled correlation coefficients (r). RESULTS: Relevant data for both genders were found in six articles. In all publications included in the meta-analysis, the total number of studied individuals was 3800, with 2054 women and 1746 men. Pooled correlation coefficient was -0,24 (95 % CI: -0.34; -0.15) in women population, and -0.12 (95 %CI: -0.16, -0.06) in men. CONCLUSIONS: Based on the published data, we found that baPWV is negatively correlated with bone density in women. However, in men we do not find such a relationship. These findings suggest the importance of considering gender-specific factors when assessing the cardiovascular and bone health relationship.

Is Balance Training Using Biofeedback Effective in the Prophylaxis of Falls in Women over the Age of 65?

The paper aims to investigate the usefulness of training in improving mobility and reducing the risk of falls of patients with osteoarthritis by using a force plate and virtual reality as rehabilitation tools. The study involved 72 women randomly divided into two equal groups: the force plate training group, which underwent virtual balance training with visual motor feedback, and the gym training group, which received conventional balance training only. The functional balance assessment was performed before and after the rehabilitation by computerized posturography in a relaxed upright position with open and closed eyes, with visual motor feedback. In the FPT group in the feedback measurement, the mean radius of sways was 30% smaller after rehabilitation (p < 0.00002); the feedback coordination coefficient was more than 10% bigger after rehabilitation (p < 0.001) and reached 92%, which is excellent for elderly people. Total stagnation and stumbling reported by patients decreased after rehabilitation compared to the first examination. Both tested forms of training can contribute to reducing the risk of falls. However, a more significant improvement was obtained in the force plate training group perhaps because the physical effort on a force plate trains the precise movements needed to reposition the centre of gravity without generating excessive inertia forces responsible for loss of balance and falls. Perhaps the most desirable method of intervention is to train a person's ability to perform slow but definite body movements.