Should information about sexual health be included in education directed toward men with cardiovascular diseases?

BACKGROUND: Modifiable risk factors contribute to the pathogenesis of cardiovascular disease (CVD) and erectile dysfunction (ED). We aimed to compare the knowledge about the contribution of modifiable risk factors to the pathogenesis of CVD and ED. The impact of patients' having modifiable risk factors on the awareness of their negative influence on the development of CVD and ED was examined. METHODS: To this multicenter cohort study, we included 417 patients with CHD who had been hospitalized in the cardiology or cardiac surgery department during the previous six weeks and underwent cardiac rehabilitation in one of the five centers. Knowledge about modifiable risk factors was collected. ED was assessed by an abridged IIEF-5 questionnaire. Comparisons between groups were conducted using the Student's t-test, Mann-Whitney U test, and Kruskal-Wallis test. Relationships were analyzed with Spearman's rank correlation coefficient. RESULTS: The mean number of correctly identified risk factors for CVD was significantly higher than those for ED (3.71 ± 1.87 vs. 2.00 ± 1.94; p < .0001). Smoking was the most recognized risk factor both for CVD and ED. Dyslipidemia was least frequently identified as a risk factor for CVD. Sedentary lifestyle was the only risk factor whose incidence did not affect the level of patient knowledge. CONCLUSIONS: Cardiac patients with ED know more about risk factors for CVD than ED. It is necessary to include information about the negative impact of modifiable risk factors on sexual health into education programs promoting healthy lifestyles in men with cardiovascular diseases.

The analysis of the parameters of 24-hr ECG Holter monitoring in patients with blood neoplasms undergoing high-dose chemotherapy and stem cell transplantation.

BACKGROUND: Hematopoietic stem cell transplantation (HSCT) is a widely used procedure in the treatment of malignant diseases, including blood neoplasms and has increased survival in hematological diseases. The aim of the study was to analyze parameters of 24-hr ECG monitoring in patients with selected blood neoplasms in whom the procedure of hematopoietic stem cell transplantation was performed. METHODS: The study group consisted of 64 adults diagnosed with hematologic cancer qualified for HSCT with the previous high dose chemotherapy (HDC). In all patients 24-hr Holter monitoring was carried out twice. First examination took place prior to the HSCT procedure, and the second after finishing the procedure of HSCT. RESULTS: The minimal and mean heart rate (HR min and HR max) from 24-hr ECG recording was statistically significantly higher after the transplantation in comparison with the first test. The number of premature ventricular complexes (PVCs) was higher in the test after HSCT. In the second examination there was significantly higher percentage of premature ventricular complexes, incidents of tachycardia, and Mobitz type 1 second degree atrioventricular block. In regression analysis, in a group of patients with blood neoplasms after HSCT and HDC, administration of cyclophosphamide, fludarabine and total body irradiation were independent risk factors for electrocardiographic abnormalities in 24-hr Holter monitoring, that is, the increase in HR min, HR mean and PVCs. CONCLUSION: In patients with blood neoplasms undergoing HSCT more electrocardiographic abnormalities may be found after this procedure in comparison with the 24-hr Holter monitoring before transplantation.

Assessment of body surface potential mapping in diabetic patients with recognized depression.

OBJECTIVES: Parameters of body surface potential mapping (BSPM) in DM II patients are significantly different comparing with healthy non-diabetic subjects. Hypothesis that these changes are more pronounced in DM II patients with depression was tested in the present study. For this purpose, analysis of the relationship between the Int-QRST (isointegral) maps distribution and the depressive symptoms intensification, as well interrelation between depressive and diabetic symptoms were performed. MATERIAL AND METHODS: BSPM registrations were obtained from the three study groups (aged 37-52 years), namely 40 diabetic patients with clinically documented depression, 30 depressive patient without DM and 90 normal subjects. BSPM recordings were displayed in a form of the Int-QRST maps. Examination with BDI and HbA1c test were also performed in all investigated subjects. RESULTS: Isointegral QRST maps turned out to display abnormal, i.e. non-dipolar distribution. Moreover, extent of Int-QRST maps multipolarity increased in the examined diabetic patients along with DM II duration, BDI scores and HbA1c level. CONCLUSIONS: Non-dipolar distribution of Int-QRST maps, more pronounced in diabetic patients with depression, can be a specific indicator of the increased risk of severe ventricular arrhythmias occurring prior to abnormalities detectable on the standard 12-lead ECG recordings, which is of great importance especially in prevention of life-threatening arrhythmias.

Heart rate variability and heart rate turbulence in patients with hematologic malignancies subjected to high-dose chemotherapy in the course of hematopoietic stem cell transplantation.

BACKGROUND: In hematological malignancies, remissions and cures may be achieved by hematopoietic stem cell transplantation (HSCT) following high-dose chemotherapy (HDC). Cardiotoxicity of such therapy has not yet been fully elucidated. Noninvasive approaches allowing to evaluate an autonomic control of the heart function include analyses of both heart rate variability (HRV) and heart rate turbulence (HRT). METHODS: In 38 patients with hematological malignancies, 24-hour electrocardiography Holter monitoring , with HRV and HRT analysis before HSCT (A test) and after HSCT (B test), was performed. RESULTS: The 24-hour analysis of HRV demonstrated that SDNN, SDNNi, rMSSD, and pNN50 parameters were significantly lower after HSCT as compared to the results obtained before the transplantation (P < 0.05). For period of diurnal activity and for night hours, SDANN, SDNNi, rMSSD, and pNN50 were significantly lower in B test, as compared to the results of A test (P < 0.05). The analysis of HRT demonstrated that turbulence onset parameter was significantly higher, and turbulence slope parameter was significantly lower in B test, as compared to A test (P < 0.05). The multifactorial stepwise backward regression analysis indicated that administration of cyclophosphamide and carmustine and higher concentrations of blood cholesterol represented risk factors for decreased HRV. Cyclophosphamide and higher triglyceride levels represented independent risk factors for decreased HRT. CONCLUSIONS: In patients with hematopoietic malignancies treated with HSCT, decreased HRV and HRT were observed after chemotherapy and stem cells administration.

[The plant anticoagulants with perspective to use in treatment of thrombosis]. / Antykoagulanty pochodzenia roslinnego z perspektywa wykorzystania w leczeniu zakrzepic.

The diseases of blood circulation system--cardiovascular diseases are the main causes of mortality in developing, low and middle-income countries all over the world. The specialists recommend the prophylaxis to avoid the dangerous complications connected with these diseases, what can reduce the final treatment costs. All over the world there is continuous research of novel, therapeutically better, more effective anticoagulant or anti-platelet agents, with multiple targets, without so many side effects. Plant material is a good source to do this kind of research. The authors show the results of their few years research on polyphenolic-polysaccharide plant conjugates, isolated from medicinal plants, popular in Poland, which is continuing in the framework of the project WROVASC--Integrated Center of Cardiovascular Medicine. This research group has been working on isolation, structure characterization and biological activity of these macromolecular compounds. Because of anticoagulant, antioxidant as well as anti-platelet properties of these plant structures they are promising to be a new source of the innovative therapeutic agent.

High-frequency changes in single-trial visual evoked potentials for unattended stimuli in chronic schizophrenia.

BACKGROUND: Patients with schizophrenia reveal changes in information processing associated with external stimuli, which is reflected in the measurements of brain evoked potentials. We discuss actual knowledge on electro- (EEG) and magnetoencephalographic (MEG) changes in schizophrenia. NEW METHOD: The commonly used averaging technique entails the loss of information regarding the generation of evoked responses. We propose a methodology to describe single-trial (non-averaged) visual evoked potentials (VEP) using spectral and statistical analyses. We analysed EEG data registered in the O1-Cz and O2-Cz leads during unattended pattern-reversal stimulation, collected from a group of adult patients with chronic schizophrenia, and compared them to those of healthy individuals. Short-time single-trial VEP were transformed to the frequency domain using the FFT algorithm. Changes of the spectral power were visualized using spectrograms which were created by stacking single-trial spectra across all trials. Measures of the absolute and the relative spectral power were calculated and compared statistically. RESULTS: In schizophrenia, the energy density of VEP oscillations is shifted towards higher (gamma) frequencies, compared to healthy individuals. These differences are statistically significant in all analysed frequency bands for the relative power. This indicates distorted early processing of visual stimuli in schizophrenia. COMPARISON WITH EXISTING METHODS: The main advantage of the presented methodology is its simplicity and ease of interpretation of obtained results. The presented observations complement the knowledge on gamma oscillations acquired from computationally more complex methods of time-frequency analysis. CONCLUSIONS: High-frequency changes for single-trial VEPs are detected in chronic schizophrenia.

Effect of kidney transplantation on heart conduction disturbances in children treated with chronic hemodialysis--a pilot study.

Aim of the study was to assess the effect of KT on heart conduction in HD children. Non-invasive electrocardiographic method of BSPM was used. Isochrone maps, presenting a VAT distribution, were taken from eight HD patients and 26 normal subjects. Patients were divided into two groups: I--three children were HD <12 months prior to KT; II--five children were HD >12 months prior to KT. After KT, the groups were marked as IP and IIP. Serum iPTH and phosphate levels were significantly higher in both HD groups than in controls, with a considerable normalization after transplantation. HD patients demonstrated neither conduction abnormalities on ECG nor left ventricular hypertrophy. Group-mean VAT maps revealed: I and II--similar patterns of complete LBBB; IP--partial normalization to a pattern of anterior fascicle block; IIP--preserved pattern of LBBB. Intraventricular conduction disturbances found in HD children using BSPM were alleviated by KT. Short HD therapy increases a chance of conduction disturbances regression after KT, contrary to the longer HD treatment. BSPM is more sensitive than standard ECG in detecting heart conduction impairments in the HD patients.

Electrocardiographic changes in workers occupationally exposed to lead.

BACKGROUND: The significance of heavy metals in pathogenesis of the circulatory system diseases remains unresolved. The aim of the study was to evaluate electrocardiographic changes in workers occupationally exposed to lead without clinical presentation of cardiac involvement. METHODS: A group of 60 smelters and refiners and 45 healthy men, as a control group, were enrolled. Twelve-lead electrocardiogram (ECG) and 24-hour Holter monitoring were performed. Further analysis included heart rate variability (HRV) in time and frequency domains and heart rate turbulence (HRT). RESULTS: Analysis of 12-lead ECG recordings revealed various pathologies in 27 out of 60 men occupationally exposed to lead. Twenty-four-hour ECG Holter monitoring showed the higher mean heart rate in copper smelters than in healthy subjects (85.8 ± 14.1 bpm vs 72.6 ± 9.2 bpm; P < 0.05) and more premature supraventricular and ventricular contractions (298 ± 235 vs 27 ± 45; P < 0.05 and 152 ± 138 vs 18 ± 18; P < 0.05, respectively). The majority of time domain and frequency domain HRV parameters were significantly lower, and the LF:HF ratio was higher when compared with the control group. Turbulence onset was abnormal in six copper smelters and turbulence slope in five men exposed to lead. CONCLUSIONS: Electrocardiographic evaluation showed that various heart rhythm disorders were more frequent in metallurgists, as compared to the control group, and the decreased HRV and abnormal parameters of HRT were observed. Noninvasive electrocardiographic evaluation could be a valuable method of the early prediction of cardiovascular disorders in men occupationally exposed to lead.

Efficacy of low energy shock-wave therapy generated using an electrohydraulic device in the treatment of ED: A systematic review and meta-analysis of randomized controlled trials. / Eficacia de el tratamiento con ondas de choque de baja energía utilizando un aparato electrohidráulico en el tratamiento de la difunción eréctil: revisión sistemática y metanálisis de ensayos randomizados.

OBJECTIVES: Over 50% of elderly men and 70% of male cardiac patients suffer from erectile dysfunction (ED). Although pharmacotherapy is effective and safe, it only brings a short-term improvement and may cause side effects. Low energy shock-wave therapy (LESWT) is a promising causative modality for the treatment of ED. The evidence is still limited with different results obtained using different devices. The aim of this work was to evaluate evidence from randomized controlled trials regarding the efficacy of LESWT generated by an electrohydraulic unit for the treatment of ED. METHODS: A systematic review of the literature was conducted in PubMed on May 20th, 2018 and supplemented by a Google search of grey literature, as well as a hand search of the bibliographies of retrieved articles. Out of 34 studies, 5 studies on 354 patients were included in the quantitative synthesis. RESULTS: The studies evaluated an abridged International Index of Erectile Function (IIEF-5), the Erectile Hardness Scale (EHS) and Flow-Mediated Dilatation (FMD). The meta-analysis revealed that LESWT improved the IIEF-5 score (mean difference: 5.16; 95% CI, 1.39-8.93; p=0.0073) and EHS score (risk difference:0.72; 95% CI, 0.73-0.80; p<0.001). Reporting of FMD was inconsistent and not analyzed. The meta-analysis of studies conducted with electrohydraulic devices showed greater benefits to patients in comparison to the meta-analyses of heterogeneous studies conducted using various devices for generating shock waves. CONCLUSIONS: Evidence exists that LESWT generated with an electrohydraulic unit is effective. Further research is needed in order to evaluate this method in different patient populations and for the long-term.

OBJETIVOS:  Más del 50% de los hombres ancianos y más del 70% de hombres con enfermedades cardiacas sufren de disfunción eréctil (DE). Aunque la farmacoterapia es efectiva y segura, solo conlleva una mejoría temporal y puede causar efectos secundarios. La terapia con ondas de choque de baja energía (OCBE) es una técnica prometedora para el tratamiento de la DE. La evidencia es aún limitada con resultados diferentes obtenidos con aparatos diferentes. El objetivo de este trabajo es evaluar la evidencia de ensayos randomizados en relación a OCBE generado con unidades electrohidráulicas para el tratamiento de la DE.MÉTODOS: Una revisión sistemática de la literatura fue conducida en PubMed el 20 mayo 2018 y suplementada por la búsqueda de Google en literatura gris. También se hicieron búsquedas individuales de artículos. De 34 estudios, 5 estudios en 354 pacientes fueron incluidos para la síntesis cuantitativa. RESULTADOS: Los estudios evaluaron abridged International Index of Erectile Function (IIEF-5), Erectile Hardness Scale (EHS) y Flow-Mediated Dilatation (FMD). El metanálisis reveló que OCBE mejoró el score de IIEF-5 (diferencia media: 5,16; 95% CI, 1,39-8,93;p=0,0073) y EHS score (diferencia de riesgo: 0,72;95% CI, 0,73-0,80; p<0,001). Los reportes de FMD fueron inadecuados y no se analizaron. El metanálisis de estudios conducidos con aparatos electrohidráulicos demostró mayores beneficios a pacientes en comparación con el metanálisis de estudios heterogéneos conducido utilizando varios aparatos generadores de ondas. CONCLUSIONES: La evidencia demuestra que OCBE generado por una unidad electrohidráulica es efectiva. Es necesaria más investigación para poder evaluar este método en diferentes poblaciones de pacientes y para el largo plazo.

The Impact of Temporary Stay at High Altitude on the Circulatory System.

In recent times many people stay temporarily at high altitudes. It is mainly associated with the growing popularity of regular air travel, as well as temporary trips to mountain regions. Variable environmental conditions, including pressure and temperature changes, have an impact on the human body. This paper analyses the physiological changes that may occur while staying at high altitude in healthy people and in people with cardiovascular diseases, such as arterial hypertension, pulmonary hypertension, heart failure, ischemic heart disease, or arrhythmias. Possible unfavourable changes were underlined. Currently recognized treatment recommendations or possible treatment modifications for patients planning to stay at high altitudes were also discussed.

Brain-stem auditory evoked potentials in children and adolescents with anorexia nervosa.

OBJECTIVE: In the course of anorexia nervosa (AN), the central nervous system (CNS) undergoes both anatomic and functional changes that may cause disturbances of stimulation transmission in the sensory areas of CNS. Method of brain-stem auditory evoked potentials (BAEPs) was used in the children with AN to test the auditory pathway transmission. MATERIALS AND METHODS: The study included 37 children and adolescents, aged 10-18 years, with clinically diagnosed AN. BAEPs were recorded after a click stimulation of 75 dB intensity. Then, wave I latency (response from the auditory nerve) and inter-peak latency I-V (IPL I-V; response from the brain-stem) were analyzed. RESULTS: Abnormalities of the BAEPs recordings were noted total in 32.4% of the study patients. Predominantly (in 24.3%), a decreased transmission within the brain-stem, expressed as the IPL I-V prolongation, was observed. It was also found that the percentage of the abnormal BAEPs results and the degree of IPL I-V prolongation were increasing together with enhancing AN severity. CONCLUSIONS: IPL I-V prolongation observed in the AN children reflects a disturbed neural transmission in the brain-stem section of the auditory pathway and can be ascribed to impairments in the nerves myelin sheath.

Cognitive disorders in type 2 diabetic patients with recognized depression.

OBJECTIVES: The most important factors in the pathogenesis of cognitive disorders in diabetes mellitus (DM) are metabolic changes directly caused by hyperglycemia. Impairment of cognitive function is accompanied by a decrease in cerebral insulin. Insulin improves cognitive processes, including somatosensoric cognitive functions. Cognitive disorders are especially pronounced if diabetic patients suffer also from depression. MATERIAL AND METHODS: The evaluation of cognitive functions, especially sensomotoric skills were obtained from three study groups (aged 37-52 years): 30 healthy subjects, 40 diabetic patients with clinically documented depression and 30 depressive patients without DM. The sensomotoric skills were carried out using a SPS-2001E apparatus - a computer working stress simulator. The examination with Beck Depression Inventory (BDI) were also performed in all the investigated persons. RESULTS: Sensomotoric skills investigation revealed slight cognitive disorders in the early stages DM (subgroup IA) and its intensification according to increasing BDI scores and HbA1c blood concentration (from subgroup IA to IC). Intensification of sensomotoric cognitive disorders was significantly higher (p<0.001) in the depressive patients with DM (group I), than in these without DM (group III). CONCLUSIONS: The obtained results suggest that coincidence of aggravating factors, such as depression and metabolic disorders in DM, may cause mutual interactions leading to premature and more intense cognitive impairment. The method proposed by the authors may serve as a screening examination in early diagnosis of CNS disorders reflected by somatosensoric cognitive disorders. The presented work indicates importance of sensomotoric skills investigation for the early diagnosis of the nervous system damage related to DM.

[Relationship between chronic exposure to lead, cadmium and manganese, blood pressure values and incidence of arterial hypertension]. / Zwiazek miedzy przewleklym narazeniem na olów, kadm i mangan a wartoscia cisnienia tetniczego oraz wystepowaniem nadcisnienia tetniczego.

BACKGROUND: Chronic exposure to heavy metals may cause the increase in blood pressure (BP). The aim of the study was to determine the relationship between chronic exposure to lead, cadmium and manganese, BP values and the incidence of arterial hypertension (AT). MATERIAL AND METHODS: The study group consisted of 171 men occupationally and chronically exposed to heavy metals (group I), and 19 healthy men included into the control group (group II). Concentrations of lead and cadmium in blood, manganese in serum, free protoporphyrins in erytrocytes, and delta aminolevulinic acid in urine as well as blood pressure were measured. Six subgroups of the exposed individuals were chosen: those exposed to lead (subgroup A), to cadmium--(subgroup B), to manganese (subgroup C), to lead and cadmium (subgroup D), to lead and manganese (subgroup E), and to cadmium and manganese (subgroup F). RESULTS: In group I, the values of systolic blood pressure and mean blood pressure were statistically significantly higher than in group II. Moreover, systolic blood pressure was significantly higher in subgroups A, B, D and E in comparison with group II. Diastolic pressure was significantly lower in group II than in subgroups A and D, and mean blood pressure was significantly higher in subgroups A, D and E in comparison with group II. The incidence of arterial hypertension was significantly higher in subgroups A and D than in group II. The independent risk factors for the incidence of arterial hypertension in the study group were higher blood concentrations of lead and, cadmium. CONCLUSIONS: In men occupationally exposed to heavy metals there is a tendency to higher levels of BP. Higher blood concentrations of lead and cadmium were found to be the independent risk factors for the incidence of arterial hypertension in subjects chronically exposed to heavy metals.

Diagnosis of hypogonadism in patients treated with low energy shock wave therapy for erectile dysfunction: a narrative review.

Several methods of treatment of erectile dysfunction (ED) are offered with low energy shock-wave therapy (LESWT) gaining increasing attention. Reports have documented that LESWT stimulates tissue neovascularization, proliferation and differentiation of endothelial cells, and production of nitric oxide - all can improve the condition of erectile tissue. However, the overall and sexual condition of men deteriorates with age which is linked with a constant decrease in testosterone concentration. A higher risk of sexual health disorders and reduced physical fitness correlates with a testosterone concentration of <12 nmol/L. Such patients may require testosterone replacement therapy. We conducted a target literature review to investigate whether testosterone concentration is taken into account in studies on the use of LESWT in the treatment of ED. We found that most studies did not provide any information on testosterone status. Only 8 of 25 studies examined showed values of testosterone concentrations. Only one of these analyses checked the relationship between the efficacy of LESWT and testosterone concentration. As a result, meta-analyses published to date may not show the full value of LESWT in the treatment of ED. We conclude that in the light of the significant role testosterone plays in the process of an erection and the mechanism of LESWT action, it can be recommended to examine testosterone concentration and to diagnose hypogonadism during the qualification of patients to studies on LESWT efficacy. Moreover, the effectiveness of LESWT in relation to the current testosterone concentration should also be further investigated.

Sexual health in Polish elderly men with coronary artery disease: importance, expectations, and reality.

Deterioration in overall health, hormonal disturbances, and erectile dysfunction (ED) contributes to limitations in sexual activity in the elderly, which is further limited by incorrect beliefs about the hazards of sexual activity in cardiac patients. We aimed to analyze the occurrence of ED in elderly men, their perception of the relevance of good sexual function, and their expectations of physicians. A cross-sectional study encompassed 731 patients with coronary artery disease (CAD) subjected to cardiac rehabilitation. Demographic data and data on modifiable risk factors and patient expectations were collected. ED was assessed using the IIEF-5 questionnaire. Relationships among the risk factors for ED, occurrence of ED, and patient expectations, as well as the changes in the indicators between 2012 and 2016, were analyzed. The mean age of men was 70.7 ± 5.1 years. The prevalence of ED was 93.0%. The IIEF-5 score was significantly associated with age, tobacco smoking, exercise tolerance, time to diagnosis of CAD, and treatment with calcium channel blockers and diuretics. Patients declared that sexual activity was overall important (47.9%) or very important (25.6%). Three hundred and sixty (49.3%) patients expected their physician to show interest in their sexual health, but the topic was addressed in only 12.5%. Over the past few years, we have observed an increase in the awareness and importance of sexual health as well as a significant increase in patients' expectations of physicians to show interest in their sexual health. Patients' expectations of discussing and receiving treatment for ED remain an unmet medical need.

Electrocardiographic evaluation in patients with systemic scleroderma and without clinically evident heart disease.

BACKGROUND: In patients with systemic scleroderma (SSc), clinically evident cardiac involvement is recognized to be a poor prognostic factor. The aim of the study was to evaluate electrocardiographic changes, parameters of heart rate variability (HRV), and heart rate turbulence (HRT) in patients with SSc without evident symptoms of heart disease. METHODS: A group of 27 patients with SSc were subjected to standard electrocardiography (ECG) examination and 24-hour Holter monitoring. Analysis of HRV in time and frequency domains, HRT, and echocardiography were also performed. RESULTS: Holter monitoring revealed a larger number of premature supraventricular contractions (PSVCs), as well as premature ventricular contractions (PVCs) in the patients with systemic scleroderma, as compared with the control group. Moreover, the SSc patients showed decreased parameters of time and frequency domains, as referred to the controls, especially during night hours. In four patients, abnormal HRT values were present. On echocardiography, only slight changes were found, however in five patients left ventricle diastolic dysfunction was diagnosed. CONCLUSIONS: The noninvasive electrocardiographic methods seems to be useful for detecting early heart involvement in course of SSc and could be recommended for routine used in clinical practice. Significance of HRT analysis in patients with SSc needs further elucidation.

Usefulness of body surface potential mapping for early identification of the intraventricular conduction disorders in young patients with chronic kidney disease.

BACKGROUND: Cardiovascular complications are considered a significant problem in patients with chronic kidney disease (CKD). Body surface potential mapping (BSPM) is a noninvasive method that is useful in detecting early changes involving the heart. The aim of the study was to evaluate possible abnormalities within the cardiac intraventricular conduction system in young patients with CKD using the BSPM method. METHODS: Based on the BSPM registrations, the QRS-T isointegral maps were created in 42 young patients with CKD (on hemodialysis, subgroup Ia; on peritoneal dialysis, subgroup Ib; on conservative treatment, group II) and in 26 healthy subjects. Serum levels of electrolytes, urea, and creatinine were also assessed in the entire study population. RESULTS: In the healthy subjects, the maximums of the group mean QRS-T isointegral map were located in the left lower anterior part of the thorax, whereas in the Ia patients, the maximums were focused at the medial sternum line. The QRS-T maps, both for Ib and II groups, showed the positive integrals covering the left part of the anterior thorax. In all the patients with CKD, standard 12-lead electrocardiogram (ECG) and echocardiography findings were within the reference range. CONCLUSIONS: In the hemodialyzed patients with CKD, the group-mean QRS-T isointegral map distribution suggested a significant delay of excitation propagation in the left bundle branch, although no abnormalities were found with standard ECG. In the patients with CKD treated with peritoneal dialysis or conservatively, the group-mean QRS-T isointegral maps were characteristic for the early phase of conduction disturbances within the left bundle branch, which again was not observed on the standard ECG recordings.

Interhemispheric cerebral asymmetry detected by VEPS in diabetic patients with recognized depression.

OBJECTIVES: The present study was undertaken in order to verify the hypothesis stating that patients with depression exhibit some abnormalities concerning a cerebral symmetry. For this purpose, an analysis of the relationship between the VEPs (Visual Evoked Potentials) results and the depressive symptoms intensification, as well interrelation between depressive and diabetic symptoms were performed. MATERIAL AND METHODS: VEPs recordings were obtained from the two study groups (both aged 20-45 years), 20 healthy subjects and 32 diabetic patients with clinically documented depression. The VEPs examination was carried out using a computer system called STELLA (Stimulated Electroencephalogram on Line Analyzer). RESULTS: VEPs examinations revealed a cerebral symmetry in the all control subjects and in 10 out of 32 diabetic patients with depressive disorders. It is noteworthy that 22 of 32 diabetic patients (68.8%) showed a hemispheric asymmetry in the VEPs recordings. Of 12 patients with a moderate depression, 10 showed the left cerebral laterality, and 2--the right laterality. In turn, all 10 patients with major depressive disorder (MDD) demonstrated in the VEPs recordings a significant cerebral laterality with the right hemisphere dominance. CONCLUSIONS: The obtained results suggest that interhemispheric cerebral asymmetry might be considered a specific feature of depression, and, if this is a case, it could justify a conclusion that right hemisphere dominance could be a neurophysiological marker of MDD. It should be emphasized that intensification of the depressive symptoms has an unfavorable influence on course of diabetes mellitus, its self-control and severity of following complications.

[Erectile dysfunction, and risk factors of cardiovascular disease]. / Zaburzenia erekcji a czynniki ryzyka choroby sercowo-naczyniowej.

The paper is a review of the reports presenting the essential aspects of erectile dysfunctions being a serious challenge for the clinicians of various specializations because of increasing number of the diagnosed cases of sexual impairments caused by atherosclerotic background. The authors present the results of the most crucial studies concerning epidemiology of the said condition, an effect of the various demographic factors on its occurrence, with the focus laid on the significant correlation between classic risk factors of atherosclerotic cardiovascular disease and reasons leading to erectile dysfunctions. The work presents also the diagnostic and therapeutic obstacles, the physicians struggling with this more and more often disease, encounter in their every day practice.

[Physical activity in basic and primary prevention of cardiovascular disease]. / Aktywnosc fizyczna w podstawowej i pierwotnej prewencji choroby sercowo-naczyniowej.

On account of the frequency of appearing and character of atherosclerosis cardiac vascular disease, one of the most crucial elements of effective fight against it is preparation of complex preventive programs including as vast number of population as possible. Consequently, Benjamin and Smitch suggested attaching the notion of basic prevention to the standard division into primary and secondary one. The basic prevention, carrying out in the general population, should concern genetic predisposition, psychosocial factors, keeping up proper body weight, healthy eating and physical activity. Especially high hopes are connected with high efficiency, simplicity and low money-consumption of preventive activities associated with physical activity modification, which has a crucial influence on reducing negative impact of atherosclerosis hazard. The results of numerous scientific research, carried out in many countries and on various, large groups, proved undoubtedly that at the healthy adult people of both sex the systematic physical activity of moderate intensification plays an essential part in preventing CVD and decreasing the death risk because of that reason as well. Moreover, systematic physical exercises show many other health-oriented actions, thanks to which they have an influence on decreasing premature and total death rate. The risk of incidence of civilization-related diseases such as diabetes type II, hypertension, obesity, osteoporosis, tumors (of large intestine, breast, prostatic gland) and depression has decreased significantly. Unequivocally positive influence has been proved at many observations dedicated to health recreational physical activity and physical activity connected with professional work based on aerobe effort. The positive effects have been also observed at children population and senior population which is more and more numerous and the most at risk. The beneficial action of physical activity is connected with direct effect on organism, which leads to adaptive changes increasing the efficiency of its functioning and, in intermediate way, modifying and reducing the influence of other risk factors of cardiac vascular disease, mainly obesity dyslipidemy and hypertension. The subsequent scientific observations had an influence on the alterations of scientific associations recommendations concerning the preferred kind, intensity and effective dose of health-oriented physical activity. The current recommendations on preventive usefulness of physical activity, implemented by Polish Cardiological Association, have been based on a document containing the guidelines of European Cardiologic Association coming from 2003. All described evidences present in unambiguous way the undeniable benefits of active lifestyle. Its promoting as well as supporting in this area vast number of population, especially in case of disturbing epidemiological data, is becoming a duty of not only health service workers but also state administration employees responsible for planning public health expenditure.