ANGIOEDEMA AFTER ANGIOTENSIN-CONVERTING ENZYME INHIBITORS.

Angiotensin-converting enzyme inhibitors (ACEI) are one of the most frequently used drugs in the therapy of cardiovascular diseases. Beneficial therapeutic effects may be accompanied by different adverse reactions including angioedema. Recently published data suggest that ACEI-induced angioedema can be life-threatening without emergent intervention, for example due to the respiratory arrest. Monitoring this adverse Jreaction may be especially important for elderly patients who probably receive many different medicines and supplements and thus might be particularly at risk of adverse drug reactions. In the paper we describe two cases of ACEI-induced angioedema in older patients.

[Addiction to benzodiazepines - analysis of patients of Independent Public Hospital for Mental Diseases Patients in Miedzyrzecz].

Benzodiazepines (BZD) are substances with proven anxiolytic, sedative, hypnotic, muscle relaxant, and anticonvulsant effect whose activity targets a macromolecular complex comprising GABAA receptors, benzodiazepine receptors and chloride channels. Broad spectrum of action of benzodiazepines affects their more and more frequent consumption by the patients, despite the reports on their addictive potential. The aim of the study was to analyze patients addicted to benzodiazepines, taking into account factors that may increase the risk of addiction. Material and Methods: The study was based on medical records of 52 patients (27 women, 25 men) of Independent Public Hospital for Mental Diseases Patients in Miedzyrzecz from January 2013 to June 2015. The initial diagnosis of admitted patients included psychiatric and behavioral disorders due to taking hypnotics and sedatives (substance withdrawal). We analyzed the amount and time of use of benzodiazepines, alcohol consumption, as well as previous therapies due to alcohol abuse or alcohol dependence. Results: Among the 52 patients (27 women, 25 men aged 26 to 68 years), the majority of city dwellers was working with secondary education Average time of benzodiazepine use was 16 years, 60% of the patients were addicted to 1 benzodiazepine, 20% to two, 10% to three, and nearly 10% to 4. Clonazepam, alprazolam and diazepam were among the most frequently abused benzodiazepines. Conclusions: More and more often observed too long term treatment with benzodiazepines poses the risk of dependence on this group of drugs.

[Efficacy of alcohol withdrawal syndrome therapy in patients from Independent Public Hospital for Mental Diseases in Miedzyrzecz]. / Skutecznosc leczenia alkoholowego zespofu abstynencyjnego u pacjentów Samodzielnego Publicznego Szpitala dla Nerwowo i Psychicznie Chorych w Miedzyrzeczu.

Consumption of alcohol is a serious social problem. Research on alcohol addicts prove that its consumption affects the physical and mental health of drinking person, his/her family and the social dimension (eg. crime, unemployment, poverty). The aim of this study was to evaluate the effectiveness of the treatment of alcohol withdrawal syndrome (AW) in patients of 2417 Unit of Treatment of Alcohol Withdrawal Syndromes of Independent Public Hospital for Mental Diseases (SPSNPCH) in Miedzyrzecz. The study was conducted in 122 of 24/7 Unit of Treatment of Alcohol Withdrawal Syndromes (SPSNPCH) treated from January to March 2015. Patients during hospitalization were subjected to intensive pharmacotherapy of AW (Stage I) and cognitive-behavioral therapy (Stage II). Of the group of 122 people starting treatment Stage I was completed by 112 patients (90%); 10 patients (8%) have been discharged at their own request. The participation in Stage II was consented only by 54 patients, of which 6 (4%) withdrew from this form of therapy. Full two-stage treatment consisting of pharmacotherapy of AWS and then psychotherapy was completed only by 48 (39%) patients.

[Analysis of the problem of addiction in the elderly]. / Analiza problemu uzaleznien w grupie osób w wieku podeszlym.

Demographic changes observed in recent decades around the world lead to the aging of societies at a rapid rate. The increasing number of elder people is a result of extending the average length of human life. Elder people are struggling with many problems--loneli- ness, disability or financial problems. The problem can also be addiction, usually suspected in young people. The aim of the study was to evaluate the prevalence of addiction--smoking, drinking alcohol, use of medicines and drugs, watching television or using the Internet--in the elderly. Additional objective was to assess the problem of sleep disorders and the purchase of OTC drugs, dietary supplements and vitamin preparations in this population. Examined group consisted of 104 people aged over 65 years, of whom only 23 were smokers and 86 were consumers of various alcohols. None of the respondents confirmed any contact with drugs and the use of addiction treatment. Only 4 respondents did not watch any TV programs and 37 did not use the Internet (nor themselves nor with the help of others). 94 respondents used drugs and non-prescription preparations. 57 responders did not experienced sleep disorders.

Seasonal and Treatment-Related Variation in 25-Hydroxy Vitamin D Concentration in Patients with Rheumatoid Arthritis.

Background/Objectives: 25-hydroxy vitamin D (25-OH-D) is a fat-soluble compound that plays many essential functions, including bone formation, neuromuscular functions, and prevention of osteoporosis and inflammation. Recent data indicate that its metabolites are associated with rheumatoid arthritis (RA) progression and neuropathic pain in RA patients. We aimed to assess the effect of RA pharmacotherapy and seasonal variation on serum levels of 25-OH-D in RA patients who received treatment with methotrexate (MTX) or leflunomide (LEF) for at least one year. Methods: This study is a retrospective analysis of data collected from 101 patients with RA who received treatment for at least one year. All of them have supplemented 25-OH-D (2000 IU daily) for at least one year. Results: We observed a significant seasonal variation in 25-OH-D concentration (p = 0.004). Moreover, there were significant differences (p = 0.03) between LEF (50.63 ± 17.73 ng/mL) and MTX (34.73 ± 14.04 ng/mL) treatment groups, but only for the summer population. A correlation was observed between 25-OH-D and RA duration-once again, in the summer population (the whole group-r = -0.64; treatment subgroups-r = -0.82 for LEF and -0.61 for MTX). Deficiency of 25-OH-D (below 20 ng/mL) was confirmed in 28.7% of patients, while 18.8% had suboptimal 25-OH-D levels (20-30 ng/mL). Conclusions: Our results showed that both RA pharmacotherapy and seasonal variation affect the serum levels of 25-OH-D in patients with active RA.

[Safety of nicotine addiction treatment]. / Bezpieczenstwo terapii uzaleznien od nikotyny.

Not all smoking addicts can succeed in quitting smoking with willpower only. These people may use nicotine replacement therapy (patches, gums, lozenges, sublingual tablets, inhalers), medicines (bupropion, varenicline and cytisine) and psychological aid. Each drug, besides its therapeutic effect, creates the risk of adverse reactions which number and severity is not always accepted by the patient. The aim of the study was to analyze adverse effects of bupropion, varenicline and cytisine formulations reported by patients. From July 2011 to June 2013 Regional Centre for Monitoring Adverse Drug Reactions (Department of Clinical Pharmacology, Department of Cardiology, Poznan University of Medical Sciences) recorded 32 suspected adverse reactions to the use of drugs for the treatment of nicotine addiction (12 after the preparation of cytisine and varenicline, 8 after preparations of bupropion). High determination caused that none of the patients withdrew from the therapy because of adverse effects.

Getting them through the door: Social and behavioral determinants of uptake and engagement in an obesity intervention.

Using data from a large-scale screening program (N = 19634), we aimed to prospectively identify factors predicting uptake (i.e. acceptance of the invitation) and engagement (i.e. participation in at least two sessions) in a multi-component-intensive-behavioral-intervention for obesity-management (MBIOM) intervention targeting adolescents (n = 2862; 12-14 years; BMI ≥90th percentile). Approximately one third of adolescents most in need of weight management declined the initial invitation to enter the MBIOM. Poor diet, sedentary behavior, and parental education predicted willingness to enter and stay in the intervention, however measured body mass index did not matter. Perceived family support, instead of initial motivation, facilitated engagement. Our results provide new insights on the importance of regional socio-geographical factors including trust in local authorities.

[The attitude of the patients with mixed addictions towards the cigarette smoking]. / Stosunek pacjentów z uzaleznieniem mieszanym do nalogu palenia.

The nicotine addiction is an important problem of people also addicted from psychoactive substances and with behavioral addictions. Therefore the article tries to answers question concerning the attitude of patients with mixed addictions (including nicotine) to cigarette smoking. The surveys were carried out in Private Psychological Clinic. Among 20 patients, 17 were addicted to alcohol, 2 to drugs and 1 to internet. All patients with mixed addictions were also treated for the habit of smoking as an addiction. The results of this study suggested that addiction to psychoactive substances and internet is strictly associated with smoking.

[Attitudes of pharmacy and dentistry students of Poznan Medical University towards smoking]. / Postawy studentów Farmacji i Stomatologii Uniwersytetu Medycznego w Poznaniu wobec nalogu palenia tytoniu.

The aim of this study was to compare the attitude of students of the Faculty of Pharmacy and Division of Dentistry (Poznan University of Medical Sciences) towards smoking. Information was collected using a self-completion questionnaire for students. 114 students of the 5th year of Faculty of Pharmacy and 60 students of 4th year of Division of Dentistry took part in the survey. Most of the students were non-smokers (77% in the Faculty of Pharmacy and 72% in the Division of Dentistry). The main reason for abandoning smoking in both groups was knowledge on the dangers of addiction obtained in medical studies.

[Pharmacovigilance of medicinal products in Poland--new guidelines]. / Monitorowanie dzialan niepozadanych produktów leczniczych w Polsce--nowe wytyczne.

The article discusses the new proposed amendments to the monitoring of adverse reactions of medicinal products.

[Nasal drops addiction--the case report]. / Uzaleznienie od kropli do nosa--opis przypadku.

The article describes the case of 34-years old man, who has used nasal drops with xylomethazoline for three years. Health consequence of uncontrolled use of the drops and treatment were prescribed. Described problem confirms the need of physicians and pharmacists cooperation to limit the problem of drug-addiction.

Fitness, Food, and Biomarkers: Characterizing Body Composition in 19,634 Early Adolescents.

Adolescent obesity persists as a major concern, especially in Central and Eastern Europe, yet evidence gaps exist regarding the pivotal early adolescent years. Our objective was to provide a comprehensive picture using a holistic approach of measured anthropometry in early adolescence, including body composition, cardiorespiratory fitness (CRF), and reported lifestyle characteristics. We aimed to elucidate potential sex/gender differences throughout and associations to biomarkers of disease risk for obese adolescents. Methods: Trained nurses measured 19,634 early adolescents (12−14-year-olds), we collected parental reports, and, for obese adolescents, fasting blood samples in four major Polish cities using a cross-sectional developmental design. Results: 24.7% boys and 18.6% girls were overweight/obese, and 2886 had BMI ≥ 90th percentile. With increasing age, there was greater risk of obesity among boys (p for trend = 0.001) and a decreasing risk of thinness for girls (p for trend = 0.01). Contrary to debate, we found BMI (continuous) was a useful indicator of measured fat mass (FM). There were 38.6% with CRF in the range of poor/very poor and was accounted for primarily by FM in boys, rather than BMI, and systolic blood pressure in girls. Boys, in comparison to girls, engaged more in sports (t = 127.26, p < 0.0001) and consumed more fast food (t = 188.57, p < 0.0001) and sugar-sweetened beverages (167.46, p < 0.0001). Uric acid, a potential marker for prediabetes, was strongly related to BMI in the obese subsample for both boys and girls. Obese girls showed signs of undernutrition. Conclusion: these findings show that overweight/obesity is by far a larger public health problem than thinness in early adolescence and is characterized differentially by sex/gender. Moreover, poor CRF in this age, which may contribute to life course obesity and disease, highlights the need for integrated and personalized intervention strategies taking sex/gender into account.

Pancreatic Injury after COVID-19 Vaccine-A Case Report.

The COVID-19 pandemic has caused more than 3 million deaths worldwide. Recently developed genetically engineered vaccines are the most critical solution for controlling the pandemic. Clinical trials on a large number of participants confirmed their safety and efficacy. However, with the growing number of vaccinated people, new infrequent adverse effects have been reported, not described in the medicinal product characteristics. We would like to report a case of acute pancreatic injury that occurred shortly after administering Pfizer BioNTech COVID-19 mRNA vaccine (Comirnaty). The report points out the potential need for close monitoring of patients reporting abdominal pain after vaccination (unresponsive to standard oral painkillers) because such symptom can be associated with acute pancreatitis.

Neopterin as a prognostic marker in patients with chronic heart failure.

BACKGROUND: The study aimed at evaluating neopterin concentration in relation to heart failure etiology and determining basal neopterin concentration in relation to the clinical state of patients after 12 months of standard treatment. MATERIAL/METHODS: The examined group was composed of 47 patients with NYHA class II and III heart failure and 20 healthy volunteers. Neopterin concentration in blood serum was determined with a radioimmunological assay. Twelve months after the patients had left the hospital, their quality of life and clinical symptoms of heart failure were evaluated. RESULTS: Statistically significantly higher basal concentrations of neopterin in the group of patients with CHF than in the control group (p<0.001) were noted. A higher concentration was found in NYHA class III than in NYHA class II CHF patients (p<0.001). No difference in relation to heart failure etiology was detected. The basal neopterin concentration determined patients' clinical status after the 12-month standard chronic heart failure treatment. CONCLUSIONS: In the 12-month observation, a relationship was detected between neopterin concentration and heart failure progression, which may point to neopterin as a marker of heart failure progression.

[The assessment of neopterin concentration in patients with heart failure]. / Ocena stezenia neopteryny u chorych z niewydolnoscia serca.

UNLABELLED: Blood serum concentration of neopterin provides knowledge about current cells immunological respond and might be used as a predictor of the progression in many disorders. THE AIM OF THE STUDY was the assessment of the blood serum concentration of neopterin in patients with heart failure and evaluation if there is any correlation between this protein and the stage and etiology of chronic heart failure (CHF). MATERIAL AND METHODS: 47 patients with chronic heart failure were studied. They were divided into two subgroups: 21 patients with the etiology of CHF caused by hypertension and 26 patients with the etiology of CHF caused by ischemic heart disease. Based on the clinical symptoms patients, 19 of them were connected into the II class and 28 into the III class of heart failure according to the New York Heart Association (NYHA) functional classification system. Control group was 20 healthy volunteers. Blood serum concentration of neopterin had been assessed using radioimmunological method. RESULTS: The concentration of neopterin was statistically higher in group of patient with CHF. No correlation between concentration of neopterin and the etiology of CHF had been observed. Concentration of neopterin in patient with class III NYHA of heart failure was significantly higher than in group of patient with class II. CONCLUSIONS: Chronic heart failure is associated with elevated blood serum concentration of neopterin. Serum concentration of neopterin does not depend on the etiology of heart failure. Heart failure progression increases neopterin concentration. In clinical practice blood serum concentration of neopterin could be considered as a prognostic factor for patients with heart insufficiency.

[The safety of pharmacotherapy in the light of monitoring adverse drug reaction]. / Bezpieczenstwo farmakoterapii w swietle monitorowania dzialan niepozadanych leków.

Main source of information about safety profile of a drug after its registration are spontaneous reports sent by skilled workers of health service. The article prescribes the analysis of adverse drug reactions registered by Regional Centre of Monitoring Adverse Drug Reactions in Poznan.

[Adverse effects of glucocorticoids. Exacerbation of iatrogenic chronic adrenal failure in patient with acute coronary syndrome treated with glucocorticoids as a result of severe obstructive pulmonary disease. Case report]. / Dzialania niepozadane glikokortykosteroidów. Zaostrzenie jatrogennej przewleklej niewydolnosci nadnerczy u chorego w przebiegu ostrego zespolu wiencowego leczonego przewlekle glikokortykosteroidami z powodu ciezkiej obturacyjnej choroby pluc--przypadek kliniczny.

The article prescribes short review of adverse effects of glucocorticoids on the basis of clinical case of exacerbation of iatrogenic adrenal failure in the course of acute coronary syndrome with ST elevation (ACS STEMI) in a patient with chronic obstructive pulmonary disease (COPD).

"PoZdro!" as an example of a successful multicenter programme for obesity management and healthy lifestyle promotion in children and adolescents - programme protocol and preliminary results from the first intervention site.

INTRODUCTION: Overweight and obesity rates in children and adolescents increase worldwide for over 30 years, what leads to an increased risk of de-veloping metabolic diseases. AIM OF THE STUDY: Protocol description and preliminary results of the largest to-date obesity management programme for children in Poland - "PoZdro!" MATERIAL AND METHODS: The Programme is based on three main steps: screening, parental engagement and long-term behavioral intervention (medical, dietetic, psychological, physical activity intervention panels) and education activities in secondary schools. Over 30.000 children were screened in four big Polish cities and over 2.000 engaged in the programme. RESULTS: Preliminary results from the first city show that, since 2014, 3998 of the 6346 (63%) eligible students from 24 schools (first grade of the secondary school) were screened. 16% of the children were overweight (body mass index - BMI ≥ 85th < 95th centile) and 4.7% were obese (BMI ≥95th centile). 603 children fulfilling the qualification (QUA) criteria (BMI > 90th centile) were offered the Individual Integrated Care (IIC). 470 (77.94% of QUA) began and 253 (41.96% of QUA, 53.82% of IIC) finished the full interventional pro-gramme with the mean BMI centile decrease of 3.04 in two following years. CONCLUSIONS: "PoZdro!" is a unique obesity prevention and management programme in Poland operating simultaneously in several Polish big cities. The programme incorporates parental engagement and long-term behavioral intervention. Preliminary results show that it may result in meaningful decrease in BMI in two following years. Further data analyses are necessary to show the influence of the programme on metabolic risk in studied group.

Is it possible to prevent chemotherapy-induced heart failure with cardiovascular drugs - the review of the current clinical evidence.

Cardiovascular diseases and cancer are the most common death causes in the USA and Europe. Moreover, many patients suffer from both of these conditions - a situation which may result from cardiotoxicity of anticancer treatment. In order to reduce the severity of this adverse effect, various methods have been proposed, including the usage of new drug forms and less toxic analogs, omitting the combinations of potentially cardiotoxic drugs and introducing potential cardioprotective agents to the therapy. However, prevention of cardiotoxicity still seems to be insufficient. The article reviews the results of current studies on the use of cardiovascular drugs in the prevention of cardiotoxicity. Based on this knowledge, the most promising cardioprotective drugs seem to be carvedilol, nebivolol, enalapril, and candesartan, as they prevent heart remodeling and correct elevated resting heart rate, which directly affects mortality. Alternatively, in case of adverse reactions, statins might be considered.

Photosensitivity reactions in the elderly population: questionnaire-based survey and literature review.

PURPOSE: Older people are at risk of developing adverse drug reactions, including photosensitivity reactions. Therefore, the aim of the study was to assess the use of potentially photosensitizing medications and photoprotection in the elderly population. PATIENTS AND METHODS: Three hundred and fifty-six respondents (223 [63%] women and 133 [37%] men) aged ≥65 years filled in the original questionnaire concerning photosensitivity reactions to drugs. The diagnosis of drug-induced photosensitivity was based on medical history and clinical examination. RESULTS AND CONCLUSION: We found that drugs potentially causing phototoxic/photoallergic reactions comprised more than one fifth of all drugs used by the participants. The most numerous group was patients treated with 3-5 drugs potentially causing phototoxic/photoallergic reactions simultaneously. Of all drugs, ketoprofen was found to cause the highest number of photosensitivity reactions. Cutaneous adverse reactions were also observed for hydrochlorothiazide, atorvastatin, simvastatin, telmisartan, and metformin. Moreover, it was found that the incidence of photosensitivity reactions can be significantly reduced by using proper photoprotection.