Use of complementary and alternative medicine in patients with cancer and their relationship with health behaviours - Cross-sectional study.

INTRODUCTION AND OBJECTIVE: Although the use of complementary and alternative medicine (CAM) is common with Polish cancer patients, little is known about cancer patients' methods of using CAM and how it correlates with their health behaviour. The aim of the study was to determine the scope of application of complementary and alternative medicine methods among patients treated by oncology and to compare the health behaviours of patients who use alternative medicine with those who do not use these methods. MATERIAL AND METHODS: The studies were conducted from August 2019 - January 2020 in an Oncology Centre in south-eastern Poland. A cross-sectional study was conducted in a group of 208 oncological patients. The authors' own questionnaire and the standardized Health Behaviour Inventory were used. RESULTS: Most of the patients (85.09%) declared that they used complementary and alternative medicine methods. 45.19% of the respondents had a high rate of health behaviours. It was observed that there was no communication related to the use of CAM among the patients and healthcare staff. Patients using CAM demonstrated more positive health behaviours than those who were not using these methods (p<0.001). CONCLUSIONS: The majority of the surveyed patients suffering from cancer used complementary and alternative medicine and declared that it was very or slightly effective in strengthening the immune system and helpful in fighting cancer. The patients who used CAM exhibited a higher level of health behaviours than those who did not use these methods.

Fever, rash, and eosinophilia - early signs of angioimmunoblastic T-cell lymphoma.

Angioimmunoblastic T-cell lymphoma (AITL) is an uncommon lymphoma of elderly adults with a poor prognosis. AITL patients show systemic symptoms, lymphadenopathy, and not infrequently, skin rash with various dysimmune phenomena rashes. The case is presented of a 68-year-old male with skin rash, lymphadenopathy and hypereosinophilia who, after investigations, was diagnosed with AITL. Despite the treatment used, the patient's condition gradually deteriorated and died due to heart and kidney failure. The diagnosis of AITL is often established only after several weeks or months because of transient physical findings, non-specific symptoms, and a broad range of serologic or radiologic abnormalities. Some patients with AITL experience non-specific dermatitis and eosinophilia. The presented case should raise awareness of the presentations of AITL which is important for physicians to reach an accurate diagnosis.

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

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.

Background ionizing radiation and semen parameters of men with reproductive problems.

INTRODUCTION AND OBJECTIVE: The male reproductive system constitutes a set of tissues which are particularly sensitive to external factors. The aim of the study was to analyze the relationship between background radioactivity and the quality of the semen of the men who have reported to the infertility treatment facility in 2000-2016 in the Lublin region of eastern Poland. MATERIAL AND METHODS: The radioactivity of the ground-level air layer obtained from the Institute of Meteorology and Water Management in Wlodawa in the Lublin region was analysed. 4,250 spermiograms of patients who reported to the treatment facility for the first time due to infertility were analysed and correlated to background radioactivity in the Lublin region in 2000-2016. RESULTS: A long-term decrease in the percentage of morphologically normal spermatozoa of the patients was observed (r=-0.970; p<0.001 in 2000-2009 and r=-0.925; p=0.003 in 2010-2016). Men's age correlated negatively with sperm motility (r=-0.164; p=0.009) and morphology (r=-0.186; p=0.009). The percentage of spermatozoa with normal morphology was lowered by beta-isotopes of artificial origin in the air in 2000-2009 (r=-0.655; p=0.040) and by the exposure to gamma radiation of the ground-level atmosphere in 2010-2016 (r=-0.676; p=0.048). The percentage of sperm vitality was lowered by gamma radiation in the atmosphere (r=-0.636; p=0.006), but improved by beta isotopes in precipitation (r=0.686; p=0.002) in the whole of the analyzed period. CONCLUSIONS: The percentage of morphologically normal spermatozoa in patients who reported to the infertility treatment depends not only on the age of patient, but also on beta-isotopes of artificial origin and gamma radiation in the atmosphere. Beta isotopes in precipitation affect the improvement of sperm vitality.

Anthropometric, body composition and behavioural predictors of bioelectrical impedance phase angle in Polish young adults - preliminary results.

INTRODUCTION AND OBJECTIVE: Bioimpedance analysis (BIA) phase angle (PhA) is an index of the integrity of cells and cellular membranes. The aim of the study was identification of behavioural and anthropometric predictors of PhA in a group of young adults. MATERIAL AND METHODS: A cross-sectional observational study of health behaviours, anthropometric indicators and body composition assessed by the BIA method was conducted in a group of Polish young adults (n=92) aged 18 - 24 (mean - 19.33, STD - 0.915). Behavioural variables included: level of physical activity, eating behaviours and nutritional knowledge. Body composition was analysed by means of BIA phase-sensitive 8-electrode medical SECA mBCA 525 device. RESULTS: The mean PhA value in the examined cohort was 6.38±0.75 (males - 7.22±0.72; females - 6.13±0.57). Males also showed higher statistically significant other body composition indices, excluding fat mass. The multiple regression model, including anthropometric variables and gender, which explained the effect of these variables on PhA, occurred to be significant (p<0.0000) and allowed explanation of the 82.49% of PhA variability. PhA was significantly predicted from body mass index (BMI), absolute fat mass, visceral adipose tissue value, skeletal muscle mass value and gender. The regression model, including behavioural predictors and gender, allowed explanation of the lower percentage of PhA variability (42.75%; p<0.0000) and included general intensity of health behaviours, level of nutritional knowledge, and gender. A regression model which would consider simultaneously anthropometric and behavioural variables could not be constructed. CONCLUSIONS: In the examined cohort, anthropometric and body composition variables showed a stronger predictive value with respect to PhA, compared to behavioural variables.

Air pollution: how many cigarettes does each Pole 'smoke' every year and how does it influence health, with special respect to lung cancer?

INTRODUCTION: Air pollution is one of the most important issues of our times. Air quality assessment is based on the measurement of the concentration of substances formed during the combustion process and micro-particles suspended in the air in the form of an aerosol. Microscopic atmospheric particulate matters (PM) 2.5 and 10 are mixtures of organic and inorganic pollutants smaller than 2.5 and 10 µm, respectively. They are the main cause of negative phenomena in the earth's atmosphere of Earth and human health, especially on the respiratory and cardiovascular systems. Particulates have the ability to cause permanent mutations of tissue, leading to neoplasms and even premature deaths. Nitrogen dioxide (NO2) is one of the main pollutants which arises mainly during the burning of fossil fuels. Based on numerous scientific researches, it has been proved that long-term exposure to NO2 could increase morbidity of cancer due to inflammatory processes increasing abnormal mutations. MATERIAL AND METHODS: Data available in the Polish National Cancer Registry, Chief Inspectorate for Environmental Protection and Map of Health Needs in the Field of Oncology for Poland, WHO Air Quality Guidelines 2005 were analyzed. Air pollution was also evaluated: PM2.5, PM10, NO2, and compared with lung cancer morbidity. RESULTS AND CONCLUSIONS: Based on the available data and literature, it can be concluded that in 2009-2017, on average, each Pole smoked ten cigarettes a day +/- 2. Therefore, it can be estimated that after 60 years everyone had 30 package-years of smoking, leading to a high risk of lung cancer and other smoking related diseases. Additionally air quality in Poland is not satisfactory, exceeding the standards presented in the WHO Guidelines 2005. It can be assumed that this may translate into an additional, independent continuous increase in morbidity and mortality dependent on smoking.

Effect of ionizing radiation on the female reproductive system.

INTRODUCTION AND OBJECTIVE: The tendency towards postponement of maternity implies a greater exposure of female germ cells to damaging environmental effects, including ionizing radiation (IR). Progress in paediatric oncology, based on the use of radiotherapy, also implies the occurrence of gonadal dysfunctions and subsequent female fertility disorders. Therefore, it seems justifiable to systematize the state of knowledge concerning the effect of IR on the female reproductive system. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: A considerable part of studies concerning the effect of IR on female germ cells have been conducted on animals. Their extrapolation to humans is hindered because in animal studies high acute exposures are applied, which do not reflect human environmental exposures characterized by chronic low dose exposure. Studies on animals provide a heterogenous image, which hinders the formulation of unequivocal conclusions and indicates that radiosensitivity depends, i.a. on IR dose, stage of development of oocytes, the applied marker of the effects of IR, or on the species. LD50 of human oocytes is estimated to be below 2 Gy. The effect of IR depends, i.a. on the dose fractionation and the age (older women are more radiosensitive). In females, the effective sterilizing dose is: at birth 20.3 Gy, at 10 years 18.4 Gy, at 20 years 16.5 Gy, whereas at 30 years 14.3 Gy, which is associated with the available pool of ovarian follicles. CONCLUSIONS: Within the range of low doses received as a result of environmental exposure to IR, there is no evidence for the occurrence of either adverse pregnancy outcomes, nor fertility disorders in females. These effects may be related to the cancer radiotherapy, or exposure to high IR doses during nuclear accidents.

Effect of ionizing radiation on the male reproductive system.

INTRODUCTION AND OBJECTIVE: In the light of current data concerning the growing exposure to ionizing radiation (IR) originating from atrificial sources, especially from medical ones, and also related to occupational exposure, it is justifiable to systematize the state of knowledge concerning the effect of IR on the male reproductive system. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: There is no basis for the application of the hypothesis of hormesis in the area of male reproductive health. Regarding the impact of IR on spermatogenesis, spermatogonia are less susceptible to the occurrence of DNA damage after exposition to IR, but are characterized by slower DNA repair compared to somatic cells. Damage to the genes after exposure to IR is possible at each stage of spermatogenesis; however, haploidal spermatids show the highest radiosensitivity in this respect. The genetic risk of the cells differentiating during spermatogenesis is limited to one cycle of spermatogenesis, whereas the genetic instability may persist for the whole period of life, and DNA damage induced by IR may be transmitted to future generations. The minimum dose causing detectable DNA damage was 30 Gy. While exceeding this dose, the number of single-strand DNA breaks increases. Among males exposed to IR, a decrease was observed in sperm motility and in the percentage of morphologically normal spermatozoa as well as in an intensification of vacuolization. The genetic material in the sperm of these males showed higher fragmentation and methylation of genomic DNA. CONCLUSION: In the context of the epidemiological situation concerning the prevalence of infertility, while assessing the health effects of exposure to IR from artificial, including medical sources, the reproductive risk should be considered.

Associations between overweight and obesity and health enhancing behaviours among female nurses in Poland.

INTRODUCTION AND OBJECTIVE: The nursing profession entails many negative factors and high risk of chronic diseases, including overweight and obesity. The aim of the study is to investigate the prevalence of overweight and obesity and health enhancing behaviours in Polish female nurses, and associations between overweight and 4 groups of such behaviours, age and shift work. MATERIAL AND METHODS: The analysis covered data obtained through cross-sectional survey carried out in a group of 994 nurses with an average age of 43. The analysis covered answers about 29 health-enhancing behaviours divided into 4 categories (subscales): 1) nutrition, 2) physical activity, 3) sleep, rest and behaviours related to mental health, 4) preventive behaviours. They were analysed through the validated Positive Health Behaviours Scale for adults. The analysis also covered answers about avoiding drinking large amounts of alcohol in one go, not smoking, avoiding passive smoking, not abusing unprescribed drugs. RESULTS: The prevalence of overweight and obesity was 44%. Of 29 health behaviours concerned with nutrition, physical activity, sleep, rest, and mental health, preventive behaviours, 3 were exhibited always or almost always by over a half of the nurses. Health behaviours were more common in nurses whose BMI was normal than in nurses with BMI ≥ 25.0. Age and low physical activity levels were related to overweight and obesity in nurses. CONCLUSIONS: The study revealed a high prevalence of overweight and obesity and many deficits in health behaviours. Obesity and health behaviour deficits pose risks to the health of nurses, limit their involvement in prevention and treatment of patient obesity and impact as health educators. It is essential to engage in actions for health promotion among nurses.

Afamin and adropin in patients with alcohol-induced liver cirrhosis.

The aim of the study was to determine serum concentrations of afamin and adropin in patients with alcoholic liver cirrhosis and to define their correlation with the stage of disease. The study included 99 patients with alcoholic cirrhosis from the region of Lublin, (Eastern Poland). Liver cirrhosis was diagnosed based on clinical features, history of heavy alcohol consumption, laboratory tests and abdominal ultrasonography. The control group consisted of 20 healthy individuals without liver disease who did not abuse alcohol. The serum afamin and adropin concentrations were determined using ELISA kits. The concentration of afamin was found to be significantly lower in patients with compensated alcoholic liver cirrhosis, i.e. P-Ch B (85.1±40.6 µg/ml) and P-Ch C (56.4±32.3 µg/ml) individuals, compared to the control group (135.9±43.6 µg/ml); p-value was <0.01 and <0.001, respectively. As far as adropin is concerned, a reverse relationship was demonstrated: the highest concentration was found in patients with P-Ch C (11.7±5.7 ng/ml) cirrhosis. Furthermore, the above concentration was significantly higher compared to patients with P-Ch A cirrhosis (7.2±2.8 ng/ml; p<0.05) and controls (7.5±2.6 ng/ml; p<0.05). The concentration of afamin decreases with the severity of alcoholic liver cirrhosis, which most likely results from impaired hepatic synthesis. Otherwise, the higher the stage of disease according to the Child-Pugh score, the higher the concentration of adropin.

Perception of preventive care and readiness for lifestyle change in rural and urban patients in Poland: a questionnaire study.

INTRODUCTION AND OBJECTIVE: The idiosyncrasies of rural health demand further research to instigate rural health initiatives and to monitor progress in rural health care. In 2008, a study examined health-related behaviour, perception of importance of preventive interventions, readiness to change lifestyle and willingness to receive support from GPs, according to gender and place of residence. MATERIAL AND METHODS: A cross-sectional survey was conducted among patients who visited any of ten randomly-selected general practices in Poland. RESULTS: Four hundred patients were enrolled: 50% from rural areas, 50.3% were females; 23.8% declared a primary level of education (35% rural vs. 12.5% urban) respondents; the median age was 50 years (IQR=18), The predicted means for prevention importance scores for rural residents were 0.623 and for urban residents - 0.682. Place of residence had a significant effect on the importance of prevention (p<0.05; ICC=0.048). Area and gender have a statistically significant effect on preventive behaviour importance scores (p<0.05; ICC=0.0526). Patient expectations of individual counselling by GPs were highest for eating habits - 35.5% rural vs. 16% urban residents (p<0.0001). CONCLUSIONS: Patient importance scores for prevention were associated with residence and gender. The villagers attached less importance to prevention. They also declared less willingness to change their lifestyle. Women had higher scores regarding prevention than men. More rural respondents would like to receive individual counselling from their GP regarding eating habits, physical activity, body weight, giving up smoking and safe alcohol use. Urban respondents were more likely to expect leaflets from their GPs on normalizing body weight.

Relationships between serum selenium and zinc concentrations versus profibrotic and proangiogenic cytokines (FGF-19 and endoglin) in patients with alcoholic liver cirrhosis.

INTRODUCTION AND OBJECTIVE: Liver cirrhosis is a disease involving the liver parenchyma, which is characterised by fibrosis and impaired architectonics of the parenchyma with regenerative nodules. The aim of the study was to determine the relationship between stage of alcoholic liver cirrhosis, concentrations of selenium, zinc and profibrotic and proangiogenic cytokines (FGF-19, ENG). MATERIAL AND METHODS: The study included 99 patients with alcoholic cirrhosis and 20 healthy subjects. Ion chromatography with UV/VIS detection was used for determination of zinc ions in the previously mineralized serum samples. The measurements of selenium were performed with the ContrAA700 high-resolution continuum source graphite tube atomic absorption spectrometer. ELISA was used to determine concentration of FGF-19 and ENG in serum samples. RESULTS: Concentrations of zinc and selenium were significantly decreased in cirrhotic patients (p<0.001 for both). The highest concentration of FGF-19 was found in Child-Pugh stage C liver cirrhosis patients (806.9±650.3 pg/ml), and was significantly higher than observed in controls (p=0.005) and stage A patients (compensated cirrhosis) (p=0.02). The highest concentration of ENG was demonstrated in the control group (3.24±148 ng/ml) while the lowest in patients with decompensated cirrhosis (7.32±5.39 ng/ml and 7.92±4.18 ng/ml for stage B and C; p=0.03 and p=0.02, respectively). The use of the multiple-variable model demonstrated that the independent factors affecting the concentration of ENG were the concentration of bilirubin (p=0.02), INR (p=0.01) and duration of alcohol abuse (p=0.02). The independent determinants of FGF-19 concentrations were found to be the stage (severity) of liver cirrhosis (p=0.04) and INR (p=0.03). CONCLUSIONS: Concentrations of zinc and selenium in serum of patients with alcoholic liver cirrhosis are not independently related to concentrations of FGF-19 and ENG.

Prevalence of cigarette smoking among adult population in eastern Poland.

Cigarette smoking is the strongest modifiable factor, which shortens the life span and deteriorates the quality of life. It increases the risk of development of cancer, cardiovascular and respiratory system diseases. The objective of the study was evaluation of the prevalence of cigarette smoking among the adult population of the Lublin Region, and investigation of the relationship between nicotinism and respondents? place of residence, and other selected socio-economic factors. Data concerning the cigarette smoking habit was obtained from 3,993 people - 2,447 females and 1,546 males; 23.0 percent of respondents in the study were smokers - 35.6 percent of males and 15.1 percent of females. The percentage of male smokers was similar in rural and urban areas. Urban females were smokers more often than those living in rural areas. A decrease was noted in the difference which has been observed to-date between the percentage of urban and rural female smokers. The highest percentage of smokers occurred among the population aged 41-50, while the lowest - among the youngest and the oldest respondents. The percentage of smoking farmers was lower than that of respondents performing non-agricultural occupations, also among rural inhabitants. Those who were occupationally active were smokers more frequently than those not engaged in occupational activity. The lowest percentage of smokers was noted among respondents who had the highest education level, while the highest percentage was observed among those who had vocational education.

Serum lipid profile and metabolic syndrome occurrence among obese rural women from Lublin Region (Eastern Poland).

Obesity is a multivariate syndrome which can negatively affect whole body functioning. It is most common in highly developed countries, and in recent years a progressive increase in obesity occurrence is noticeable. The aim of the study was to assess serum lipid profile and metabolic syndrome occurrence among obese rural women from Lublin Region in Eastern Poland. The study was conducted in the Institute of Agricultural Medicine in Lublin (IAM). All subjects had a negative history of diseases and treatment that could affect serum lipid profile or glucose measurements. The inclusion criterion for the study group was overweight and obesity, defined as a body mass index above 25 (BMI > 25) and living in a rural area. 44 women participated in the study. There were no women fulfilling the criteria or who had a history of incorrect fasting glucose (IFG) or incorrect glucose tolerance (IGT). In contrast, the prevalence of arterial hypertension (or treatment) was high - 53%. 22.7% women had normal serum TC values. The proportion of those with hyper-LDL-C was 38.6% and with hyper-TG - 18.2%. 20.5% of studied women had incorrect serum HDL-C levels, and in 15.9% hypo- HDL-C was accompanied by high serum TC levels. Analysis of correlation showed that serum TC was positively correlated with both LDL- and HDL-C. 55% of the studied obese or overweight women had at least 2 additional components of the metabolic syndrome.

Prevalence of obstructive respiratory disorders in the rural population of the Lublin region.

The subject of the study was to analyze spirometric data provided by comprehensive research programme of Institute of Agricultural Medicine in Lublin. Field research was conducted in the years 1999--2001 to evaluate the prevalence of selected respiratory system diseases. The basic measurements were forced expiration maneuver performed and interpreted on the strength of ATS recommendations, physical examination and medical history (especially lower respiratory airways obstruction symptoms). The two-stage random sample of population of 4 eastern part of Lublin region communes was the studied material (660 people). The aim was to evaluate the incidence of airways obstruction and then chronic obstructive pulmonary disease. Next, we wanted to asses--the main clinical symptoms of disease and what percentage of disease cases are diagnosed/treated by the health care system. Based on our results the incidence of airways obstruction in the population examined is excessive (11%), typical of populations exposed to respiratory risk factors. There were no clinical manifestations in the 50% of cases with spirometric diagnosed obstruction and incidence of severe, symptomatic forms of obstructive diseases was low. 75% of obstructive patients have never been diagnosed by health care system and a very low percent has been properly treated with personal drug inhalers. Our study confirms that chronic obstructive lung disease is an essential problem also in the Polish rural population. Patients belittle early symptoms of COPD and health care system is insufficient in detection and treatment of this disease.