Adherence to therapy among liver transplant patients as related to depression, anxiety, acceptance of the disease, and social support.

OBJECTIVE: This study aimed to assess the patients' adherence to therapeutic regimens after liver transplantation, taking into account the levels of depression and anxiety, acceptance of the disease, and social support. PATIENTS AND METHODS: The study group included N = 112 patients selected from 669 patients after liver transplantation. The Delphi method was used to develop a tool to assess the level of adherence to treatment regimens. The sources of data for this study were recommendations and the work of an expert panel. The next method used in the study was a diagnostic survey based on the following standardized research instruments: Inventory of Socially Supportive Behaviors (ISSB), Acceptance of Illness Scale (AIS), Beck Depression Inventory-II (BDI-II) and State-Trait Anxiety Inventory (STAI). RESULTS: The study group showed a medium level of adherence to therapeutic recommendations (6.8 ± 1.85). We observed a statistically significant positive correlation between acceptance of the disease and adherence to therapeutic recommendations (r = -0.20, t = -2.040, p = 0.044). Among the factors analyzed, six predictors were identified that significantly affect the level of adherence to therapeutic recommendations in a group of liver transplant patients. CONCLUSIONS: 1. Patients who accept their disease are a group of people who significantly worse adhere to therapeutic recommendations. 2. The main positive predictors of treatment adherence in the group of transplant patients are the search for various sources of information and declarative adherence to treatment recommendations. Negative predictors include the duration of the disease, side effects of the applied treatment, and comorbidities. 3. The patients who were informed that results depend on regular medication intake significantly more often followed therapeutic recommendations.

Diagnostic markers of insulin resistance to discriminate between prediabetes and diabetes in menopausal women.

OBJECTIVE: Menopause is an important transition period in a woman's reproductive life during which hormonal changes occur, resulting in an increased risk of cardiovascular disease and type 2 diabetes. In this study, we assessed the possibility of using surrogate measures of insulin resistance (IR) to predict the risk of insulin resistance in perimenopausal women. PATIENTS AND METHODS: The study involved 252 perimenopausal women living in the West Pomeranian Voivodeship. The methods employed in this study were diagnostic survey based on the original questionnaire, anthropometric measurement, and laboratory tests performed to determine the levels of selected biochemical parameters. RESULTS: In the entire study population, the highest area under the curve was found for the homeostasis model assessment-insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI). Triglyceride-glucose index (TyG index) showed a higher diagnostic value as a distinction tool between prediabetes and diabetes in perimenopausal women than the other markers. HOMA-IR significantly positively correlated with fasting blood glucose (r = 0.72; p = 0.001), glycated hemoglobin (HbA1C, r = 0.74; p = 0.001), triglycerides (TG, r = 0.18; p < 0.005), and systolic blood pressure (SBP, r = 0.15; p= 0.021), and negatively with high-density lipoprotein (HDL, r = -0.28; p = 0.001). QUICKI negatively correlated with fasting blood (r = -0.051; p = 0.001), HbA1C (r = -0.51; p = 0.001), TG (r = -0.25; p = 0.001), low-density lipoprotein (LDL, r = -0.13; p= 0.045), and SBP (r = -0.16; p = 0.011), and positively with HDL (r = 0.39; p = 0.001). CONCLUSIONS: Anthropometric and cardiometabolic parameters were found to significantly correlate with IR markers. HOMA-beta, the McAuley index (McA), visceral adiposity index (VAI), and lipid accumulation product (LAP) may be useful as predictors of pre-diabetes and diabetes in postmenopausal women.

Analysis of the laboratory results of the patients enrolled in the Nutritional Therapy Program.

OBJECTIVE: Nutritional treatment is an integral part of patient management, as meeting nutritional needs significantly contributes to improving treatment outcomes and reducing complications and length of hospitalization. The aim of this study was to analyze the laboratory results of the patients enrolled in the Nutritional Therapy Program. PATIENTS AND METHODS: This study involved 103 subjects, aged 18-88. It was based on analysis of medical documentation of patients under the care of the Enteral Nutrition Clinic. Nutritional status was assessed by biochemical tests (urea, creatinine, AST, ALT, ALP, CRP, total cholesterol, triglycerides, INR, Na, K, Cl, Mg, Ca, P, Fe, total protein, albumin, and fasting glucose). RESULTS: After six and twelve months, the groups with malnutrition and neurological diseases had higher levels of erythrocytes and albumin, and significantly lower CRP. The mean glucose level after six months was significantly lower compared to the first measurement, and a downward trend was observed. Calcium showed an upward trend. In cancer patients, a decline in erythrocytes was observed after six months compared to the initial measurement. CONCLUSIONS: There were significant differences in the results of laboratory tests between patients with cancer and those with malnutrition and neurological diseases. These were mainly lower levels of lymphocytes and glucose, and higher levels of platelets and CRP. Furthermore, the greatest effect of nutritional treatment was observed in patients with malnutrition and neurological diseases.

The effect of vitamin D levels on lipid, glucose profiles and depression in perimenopausal women.

OBJECTIVE: Vitamin D deficiency is a significant problem that affects the population living in most countries. This issue is independent by place of residence, sex, age or skin color. It is mainly influenced by the environment we live in and by an unhealthy lifestyle, including bad eating habits. The aim of this study was to evaluate lipid profile, glucose levels, and vitamin D levels, considering sociodemographic variables, smoking and alcohol consumption in perimenopausal women. Depressive mood was also assessed considering sociodemographic variables and vitamin D levels. PATIENTS AND METHODS: The study was conducted on a group of 191 women and performed in two stages. The first of them was carried out using a diagnostic survey with the use of a technique questionnaire. The applied research instruments were the author's questionnaire (concerning sociodemographic and selected medical data), and the Beck Depression Inventory. The second stage of the study involved the collection of peripheral blood from each respondent, in order to determine lipid profile, glycemia and serum vitamin D levels. RESULTS: The age of the female respondents ranged from 45 to 65 years, mean age was 53.1 ± 5.37 years, median 53 years. Vitamin D levels were below normal in 78%; 77% had elevated total cholesterol levels; 91.6% of the respondents had high density lipoprotein (HDL) cholesterol levels within the normal range; 64.4% was characterized by too high (low-density lipoprotein) LDL cholesterol, and 84.8% of the women showed normal triglyceride levels. Among the respondents, 91.1% had normal glycemic levels. Analysis of the collected data showed a weak negative correlation between serum vitamin D levels and the levels of total cholesterol (rho=-0.14; p=0.05), LDL cholesterol (rho=-0.16; p=0.026), and triglycerides (rho=-0.22; p=0.002). Only in the case of HDL cholesterol (p=0.067), there was no statistically significant correlation. There were also no statistically significant correlations between serum vitamin D levels and glycemia or severity of depression. CONCLUSIONS: 1. The majority of the women did not manifest depressive disorders. Of all factors analyzed, only education was associated with the severity of depressiveness. 2. Smoking adversely affected serum vitamin D levels in the studied women. 3. The cessation of menstruation affected carbohydrate metabolism and vitamin D levels. Blood glucose levels increased with the age of the studied women. 4. Relationships were found between the levels of vitamin D and the levels of total cholesterol, LDL cholesterol, and triglycerides. Therefore, it is important to maintain normal vitamin D levels.

Elevated serum fluoride levels in perimenopausal women are related to the components of metabolic syndrome.

OBJECTIVE: Increased fluoride levels can lead to numerous complications, including skeletal effects, cardiotoxicity, endocrine dysfunction, neurotoxicity, hepatotoxicity and nephrotoxicity. The aim of this study was to analyze the relationship between serum fluoride levels and MetS or its individual components, and to assess the diagnostic usefulness of fluoride as a factor contributing to MetS. PATIENTS AND METHODS: The study included a group of 475 women (mean age of 52.9 years), living in the West Pomeranian Voivodeship in Poland. The study involved data collection and biochemical analysis. RESULTS: Analysis of the relationship between the levels of fluoride and the presence of MetS or its components showed that the mean fluoride level was statistically significantly higher in patients with hypertriglyceridemia (dCohen = 0.39; 95% CI; confidence limits: 0.13, 0.63) and hypertension (dCohen = 0.25; 95% CI; confidence limits: 0.07, 0.44). Moreover, the mean fluoride level was significantly higher in women who met the diagnostic criteria for MetS than in the remaining subjects (dCohen = 0.40; 95% CI; confidence limits: 0.17, 0.64). CONCLUSIONS: Elevated serum fluoride levels may be associated with an increased incidence of MetS among perimenopasal women, although its diagnostic value as a marker of MetS is limited.

The effect of tryptophan and serotonin levels on the severity of depressive and climacteric symptoms in perimenopausal women.

OBJECTIVE: The dysfunctional serotonergic system is a factor contributing to the development of depression. The aim of this study was to assess the effect of serotonin and tryptophan on the severity of climacteric and depressive symptoms in perimenopausal women. PATIENTS AND METHODS: The study involved data collection and biochemical analysis. The research instruments were: the Blatt-Kuppermann index, the Beck Depression Inventory, and the proprietary questionnaire. RESULTS: There was no significant effect of tryptophan (r=0.05; p=0.219) and serotonin (r= -0.03; p=0.537) on the severity of depressive symptoms, or tryptophan on the severity of climacteric symptoms (r=0.019; p=0.657). However, a weak negative correlation was found between the level of serotonin and the severity of climacteric symptoms (r=-0.09; p=0.022). Additionally, it was found that severe depressive symptoms were associated with a significant exacerbation of climacteric symptoms (ß=0.379; p<0.001), while higher serotonin levels alleviated them (ß=-0.604; p=0.005). CONCLUSIONS: Higher severity of depressive symptoms may exacerbate climacteric symptoms. Serotonin levels may influence the severity of climacteric symptoms. Moreover, the higher the serotonin level, the lower the odds of depressive disorders, irrespective of the severity of climacteric symptoms. Tryptophan levels had no effect on the severity of depressive and climacteric symptoms in the perimenopausal women.

Can personality traits affect the quality of life of women with the BRCA1/BRCA2 mutations before and after prophylactic adnexectomy?

OBJECTIVE: Ovarian, fallopian tube, and peritoneal carcinomas are the most common hereditary gynecological cancers associated with the BRCA1 and BRCA2 mutations. It is recommended to radicalize management, using RRSO. Personality traits are regarded as significant contributors to human QoL and adaptability to the changed conditions of functioning. The aim of this study was to demonstrate the effect of personality on the QoL of women with the BRCA1 and BRCA2 mutations before and after RRSO. PATIENTS AND METHODS: The study involved 62 patients with the BRCA1 and BRCA2 mutations referred to hospital for RRSO. The research instruments were the WHQ, NEO-FFI, and self-developed sociodemographic data collection tool. RESULTS: Highly neurotic patients with the BRCA1 and BRCA2 mutations had lower QoL, especially in the domains of depressed mood, anxiety/fears, and sleep problems. At the same time, higher levels of conscientiousness, openness to experience, extroversion, and agreeableness were associated with better QoL outcomes. CONCLUSIONS: (1) Personality traits can contribute to the QoL of women with the BRCA1 and BRCA2 mutations before and after RRSO. (2) Identification of personality traits may be an important prognostic factor indicating potential changes in the QoL of patients after RRSO.