[The prognostic value of basic laboratory blood tests in predicting the results of cardiac rehabilitation in post STEMI patients]. / Wartosc prognostyczna podstawowych badan laboratoryjnych krwi w przewidywaniu wyników rehabilitacji kardiologicznej u chorych po STEMI.

UNLABELLED: The possibility of complications and death from cardiovascular causes in patients with acute coronary syndromes (ACS) is an important element in the assessment of their clinical condition. It is believed that the prognosis of patients after ACS is affected, among others, by leukocytosis, anemia, hyperglycemia, thrombocytopenia, and increased volume of these cells and decreased GFR. AIM: The aim of the study was an attempt to use basic laboratory blood tests and an index of own design to predict the results of in-hospital cardiac rehabilitation (phase II) of post STEMI patients. MATERIALS AND METHODS: The study included 100 post STEMI patients, 70 men and 30 women, aged 60,9±11,8 years, admitted for cardiac rehabilitation to the Department of Internal Diseases and Cardiac Rehabilitation, MU in Lodz. On admission fasting blood cell count was performed, serum glucose and creatinine level was determined (GFR assessment). The following results were considered abnormal: glucose level ≥100mg/dl, GFR <60 ml/min/1,73m(2), RBC <4x10(6)/µl, WBC >10x10(3)/µl, PLT <150x10(3)/µl. Exercise test was performed twice in all patients - before and after the completion of the II phase of rehabilitation to assess its effects. RESULTS: Basing on logistic regression analysis and the results of individual odds ratio (OR) of the tested blood parameters, their prognostic impact on the risk of cardiac rehabilitation failure was determined. This risk was defined on the basis of patient's inability to tolerate workload increment ≥20 Watt despite the applied cardiac rehabilitation program. The most statistically significant risk factors were selected as the result of logistic regression model building on the basis of which cardiac rehabilitation failure index was determined. Leukocytosis and anemia determined most significantly the failure of cardiac rehabilitation (respectively: OR=6,4 and OR=2,9;p=0,01). They were used to construct a rehabilitation failure index with the values 0-2, as follows: 0 - corresponds to the situation of the absence of leukocytosis and anemia, 1 - corresponds to the situation of the occurrence of leucocytosis or anemia in post STEMI patients and was associated with 3,5-fold increase in the risk of not obtaining the full effect of cardiac rehabilitation, 2 - corresponds to the situation of the simultaneous occurrence of both parameters (leukocytosis and anemia) and was associated with 12,25-fold increase in the risk of not obtaining full effect of cardiac rehabilitation. CONCLUSIONS: Peripheral blood cell count is essential in predicting cardiac rehabilitation effects. Leukocytosis and anemia determine to the greatest degree the failure of cardiac rehabilitation. Cardiac rehabilitation failure index may be useful in classifying post STEMI patients into an appropriate model of rehabilitation.

[The prognostic value of hyperglycemia, leukocytosis and decreased glomerular filtration rate in acute coronary syndromes--pharmacological protection capabilities]. / Wartosc rokownicza hiperglikemii, leukocytozy i obnizonego przesaczania kebuszkowego w ostrych zespolach wiercowych--mozliwosci ochrony farmakologicznej.

The evaluation of the risk of complications and death from cardiovascular causes is conducted in all patients with acute coronary syndromes (ACS) using a variety of methods. The assessment of the risk of cardiovascular events, including also death, the cause of which are cardiovascular diseases, is a very important and essential part of clinical evaluation. Moreover, all patients with ACS are assessed as regards the risk of complications and in-hospital mortality and the short- and long-term patient outcomes. Recently, in the prognostic assessment of ACS patients attention has been paid to hyperglycemia, leukocytosis, and decreased GFR, which might worsen the prognosis. Hyperglycemia on admission and especially its occurrence and persistence during hospitalization speak for particularly poor prognosis. Furthermore, the annual and long-term mortality rate is observed to increase with the higher HbA1c level, regardless of the glucose concentration on admission to hospital. Increased risk of the occurrence of cardiovascular events is observed with the intensity of the inflammation which is reflected, among others, in elevated number of peripheral blood leukocytes. Attention is drawn to the higher rate of complications in patients with increased baseline leukocytosis. The correlation between the increase in leukocyte count and all-cause mortality is statistically significant. A higher risk of non- fatal myocardial infarction is also observed with the increase of leukocytosis. Neutrophils, which are the main pool of white blood cells, and whose activation is observed during PCI, may play a role in these unfavorable phenomena. This activation results in increased production of oxygen free radicals by these cells, intensification of adhesion and aggregation. A number of studies point to the cardioprotective mechanism of action of statins (anti-inflammatory and anti-thrombotic) in patients with ACS. The use of leukocyte reduction filters in patients during CABG may be one of the methods limiting the impact of leukocytosis on cardiovascular events in patients with ACS. Renal failure is a strong and independent predictor of mortality in patients with ACS. Contrast-induced nephropathy is a complication following coronarography which is performed in patients with ACS for diagnostic and therapeutic purposes. Hyperglycemia also has an adverse effect on this complication. The prevention of contrast-induced nephropathy includes the use of statins prior to PCI.

[The ability to pharmacological control of anemia and thrombocytopenia in patients with acute coronary syndromes]. / Mozliwosc kontrolowania farmakologicznego niedokrwistosci i maloplytkowosci u chorych w ostrych zespolach wiencowych.

Recently, attention has been paid to anemia (decreased number of red blood cells in peripheral blood and less than the normal quantity of hemoglobin) apart from the traditional methods used in determining prognosis in patients with acute cardiac syndrome (ACS). Thrombocytopenia and increased mean platelet volume (MPV) are listed among other--yet simple--laboratory blood tests which have prognostic significance in patients with ACS. In ACS patients it is necessary to distinguish between anemia which is established on admission to hospital (chronic anemia) and that acquired in the hospital (HAA). Anemia diagnosed on admission is an independent predictor of in-hospital mortality, short term and long term. In tum, hospital-acquired anemia is associated with the increase of in-hospital mortality, which further increases with greater decrease in Hb concentration. The prognostic value of Hb concentration was evaluated among others in patients with myocardial infarction. There was no beneficial effect of erythropoietin in patients with STEMI undergoing PCI, on the contrary, the increase of the adverse cardiovascular events and the risk of thromboembolic events was observed in selected groups of patients. The need of the administration of iron preparations is indicated in the case of anemia associated with iron deficiency or due to major bleeding. It was found that in patients with ACS even mild thrombocytopenia increases the risk of bleeding complications and in-hospital mortality, the risk of reinfarction, cardiogenic shock and stroke. Worse prognosis in patients with ACS is also associated with a decreased platelet count on admission to hospital and with increased mean platelet volume. In patients with ACS, we deal with heparin-induced thrombocytopenia or thrombocytopenia caused by the use of antiplatelet agents. The treatment of these causes of thrombocytopenia is an important issue. Increased platelet reactivity is observed in patients with increased MPV. This results in the development of restenosis, worse blood flow after PCI, in the increase in mortality and a higher incidence of the phenomenon of "no-reflow". The use of abciximab in STEMI and NSTEMI was associated with a decrease in MPV. Statins also caused a significant decrease in MPV.

[Evaluation of effects of cardiac rehabilitation in patients after coronary artery bypass grafting by six minute walk test]. / Ocena efektów rehabilitacji kardiologicznej u chory4 po zabiegach pomostowania aortalno-wiencowego przy uzyciu testu 6-minutowego marszu.

UNLABELLED: Exercise capacity testing is a procedure that enables enrollment into cardiac rehabilitation (CR) and CR effects evaluation. Six minute walk test (6MWT) is an easy and measurable method of exercise capacity assessment in patients after acute coronary syndrome (ACS). The aim of study was to evaluate effects of CR in patients after cardiac surgery for ACS using 6MWT MATERIAL AND METHODS: 50 patients (aged 41-65 years; mean age 56.7 +/- 9.1; 43 male and 7 female) after cardiac surgery for ACS NSTEMI were enrolled into the study. 6MWT was performed on admission and after the second stage of CR. RESULTS: The mean 6MWD (expressed in meters +/- SD) was 522.14 +/- 69.5 before CR and 584 +/- 70.8 after 4-week-long CR period (p < 0.05). The mean distance walked in patients before CR was 138,16% of recommended minimal value; in patients after CR was 154.37% of recommended minimal value, respectively, (p < 0.05). The mean distance walked by patients before CR was 98.26% of the recommended mean value; in patients after CR it was 109.83% of the recommended mean value, respectively (p < 0.05). None of the performed tests required interruption and none of the individuals required assistance during 6MWT. CONCLUSIONS. In patients after cardiac surgery 6MWT is a useful method of CR effects evaluation. Test is a well-tolerated and safe procedure for assessment of functional capacity in patients after cardiac surgery with an increased risk of ACS and reduced exercise capacity.

[Oxidative-reductive balance in patients after acute coronary syndrome that undergo cardiac rehabilitation]. / Ocena równowagi oksydacyjno-redukcyjnej krwi u chorych po ostrych zespolach wiencowych poddanych rehabilitacji kardiologicznej.

UNLABELLED: Cardiac rehabilitation is essential part of acute coronary syndrome (ACS) treatment. Controlled physical activity (both aerobic exercise and muscle-strengthening activities) is the most important part of cardiac rehabilitation (CR). There is a close relationship between regular physical exercise and secondary prevention in patients after ACS. However, influence of physical activity on antioxidative protection mechanisms and free radical reactions is not yet fully known. The aim of study was to evaluate CR effects (the second phase) on oxidative-reductive balance in patients after ACS hospitalised for CR. MATERIAL AND METHODS: Our study comprised 50 patients (32 male, 18 female), aged 42-75 years (56.42 +/- 8.34) after ACS treated by percutaneous transluminal coronary angioplasty (PTCA), that subsequently underwent the second phase of CR. Interval cycloergometer training was performed five times a week (in total 15 training sessions). In addition to interval training, patients underwent individual breathing exercises, relaxation exercises, isometric exercises of particular muscle groups and general rehabilitation twice a day. Thiobarbituric acid reactive substances (TBARS) level in erythrocytes, total antioxidant status (TAS) of plasma, superoxide dysmutase-1 (SOD-1), catalase (CAT) and glutathione peroxidase (GSH-Px) activity in erythrocytes were determined before and after CR programme. Statistical analysis of physical activity influence on oxidative-reductive balance was performed by Wilcoxon matched pairs test. P < 0.05 was acknowledged as statistically significant. RESULTS: After rehabilitation programme in patients after ACS following significant results were found: increase in SOD-1 activity compared to baseline values (3624.22 +/- 1003.38 U/gHb vs 3086.71 +/- 683.14 U/gHb; p = 0.007), increase in GSH-Px activity compared to baseline values (41.27+/- 13.87 U/gHb vs. 38.02 +/- 13.98 U/gHb; p = 0.006), decrease in CAT activity compared to baseline values (17.30 +/- 4.87 U/gHb vs. 19.64 +/- 4.36 U/gHb; p = 0.001), increase in TAS level compared to baseline values (2.00 +/- 0.75 mM/L vs. 1.66 +/- 0.71 mM/L; p = 0.003), increase in TBARS level compared to baseline values (0.21 +/- 0.05 microM/gHb vs. 0.19 +/- 0.03 microM/gHb; p = 0.0006). CONCLUSIONS: Improvement of antioxidative protection in patients after ACS was observed after cardiac rehabilitatiom programme. Increase in SOD-1 and GSH-Px activity in erythrocytes and TAS plasma level was found. Increase of TBARS level in erythrocytes in patients after ACS and subsequent cardiac rehabilitation is associated with intensification of free-radical chain reaction related to physical activity.

[Assessment of the clinical symptoms and treatment tolerance in patients with non-small cell lung cancer (NSCLC) undergoing first-line chemotherapy and pulmonary rehabilitation]. / Ocena stanu klinicznego I tolerancji leczenia u chorych na niedrobnokomórkowego raka pluca poddanych chemioterapii pierwszorzutowe i rehabilitacji oddechowej.

UNLABELLED: In Poland lung cancer is the most commonly occurring cancer type, both in men and women. Among the most important concerns related to this disease are clinical symptoms caused by deteriorating physical condition and intolerance to chemotherapy. The aim of this work was the assessment of the clinical symptoms and treatment tolerance in patients with non-small cell lung cancer (NSCLC) undergoing first-line chemotherapy and pulmonary rehabilitation. MATERIALS AND METHODS: 90 patients with inoperable NSCLC have undergone the examination. This included 69 men and 21 women aged between 46-75 years (average age 61.5 +/- 8.2 years). These were divided into 3 groups: group 1--30 patients undergoing standard chemotherapy; group II--30 patients undergoing standard chemotherapy and pulmonary rehabilitation; group Ill--30 patients undergoing standard chemotherapy and pulmonary rehabilitation with additional vitamin C supplementation. Clinical symptoms intensification was assessed using the ESAS scale (Edmonton Symptom Assessment System), by comparing the initial score with that after 6 weeks of chemotherapy in each individual. RESULTS: In groups II and III, where pulmonary rehabilitation was carried out, the intensification of the clinical symptoms and lowering of the tolerance for the treatment after 6 weeks of first-line chemotherapy were significantly lower (p < 0.05) than in group I. CONCLUSIONS. Pulmonary rehabilitation significantly limits the side effects of chemotherapy and the deterioration of the state of patients with NSCLC. Simultaneous supplementation with ascorbic acid increases the positive effects of pulmonary rehabilitation in those patients.

Blood gas analysis, blood saturation and chosen parameters of spirometric examination in NSCLC patients undergoing chemotherapy and pulmonary rehabilitation.

UNLABELLED: In industrialized countries lung cancer is associated with highest mortality among carcinoma. Progression of the disease is associated with diminished tolerance for physical activities, aggravated dyspnea and lowering of life quality. The aim of study was the evaluation of blood gas, blood saturation and chosen parameters of spirometric examination in NSCLC patients undergoing chemotherapy and pulmonary rehabilitation. Analysis of capillary blood was done using RapidPoint 405 Siemens device. Spirometric examination was done using PNEUMO abcMED device. MATERIAL AND METHODS: Forty-nine patients with inoperable NSCLC were subjected to the examination. This included 38 men and 11 women aged between 46-75 years (mean age 63 +/- 7.5 years) who were separated into two groups: group I--25 patients undergoing standard chemotherapy (group C); group II--24 patients undergoing standard chemotherapy and pulmonary rehabilitation (group CK). All patients were subjected to blood gas analysis, blood saturation analysis and spirometric examination twice, before and after first-line chemotherapy RESULTS: Increase of pO2 and SaO2 in blood, and FEV1 and FVC in spirometric examination was significantly higher in patients undergoing pulmonary rehabilitation and chemotherapy (group II) (p < 0.05) in comparison to NSCLC patients undergoing only chemotherapy (group I). CONCLUSIONS: Pulmonary rehabilitation of NSCLC patients undergoing first-line chemotherapy results in improvement of indicators of blood gas, blood saturation analysis and chosen parameters of spirometric analysis. Pulmonary rehabilitation in patients with lung cancer seems to be an important form of supplementary treatment.