Anthropometric Factors in the Assessment of Obstructive Sleep Apnea Risk in Patients with Metabolic Syndrome.

Metabolic syndrome (MetS) and obstructive sleep apnea (OSA) are related to a higher incidence of cardio-vascular diseases and mortality in patients. The aim of the study was to define the potential use of anthropometric factors for the evaluation of OSA risk in patients with diagnosed MetS. The patient group consisted of 50 obese men with MetS (mean age 49 ± 9 years). The following anthropometric indices were assessed: body mass index (BMI), neck circumference (NC), waist circumference (WC), and waist-to-hip ratio (WHR). In addition, blood glucose and lipid profile were investigated. On the basis of polysomnography, clinical symptoms, and Epworth Sleep Scale, patients were stratified into the OSA group accompanied by MetS (n = 31) and the MetS alone group taken as control (n = 19). OSA was evaluated as severe in 26 out of the 31 patients (>30 apneic episodes per hour). We found a significantly larger NC in the OSA with MetS group then that in the MetS alone group. Further, NC associated with the increase in the apnea/hypopnea index. However, the other anthropometric indices investigated failed to differentiate the two groups. We conclude that increased neck circumference in patients suffering from metabolic syndrome is a risk factor for the development of OSA.

Serum estradiol concentration, estradiol-to-progesterone ratio and sputum IL-5 and IL-8 concentrations are increased in luteal phase of the menstrual cycle in perimenstrual asthma patients.

SUMMARY: Background. The results of the research on perimenstrual asthma (PMA) pathophysiology are inconsistent, and the role of sex hormones remains inconclusive. The aim of the study was to evaluate the influence of serum sex steroid (and other) hormones concentrations on lower airway inflammation of PMA patients. Methods. Thirty-three women of childbearing age diagnosed as: PMA (n = 13), non-PMA asthmatics (n = 10), and healthy controls (n = 10) were prospectively followed for 12 weeks over 2 consecutive menstrual cycles. On the 10th and 26th day of each cycle serum 17ß-estradiol, progesterone, testosterone, androstendion, dehydroepiandrosteron, cortisol, thyroid-stimulating hormone and prolactin were measured, and sputum was induced. Sputum inflammatory cell count and IL-5, -6, -8, -10 concentrations were determined. Results. When compared to non-PMA asthmatics, the luteal phase of the cycle in PMA subjects was associated with increased serum estradiol concentration, estradiol-to-progesterone ratio (p < 0.001, p = 0.001, respectively) and sputum IL-5 and IL-8 concentrations (p = 0.045, p = 0.039, respectively). Decreased serum testosterone levels (p < 0.05) and a trend to increased serum prolactin levels in both phases of the menstrual cycle in PMA subjects were observed. Sputum analysis in PMA patients revealed increased total inflammatory cell count in both phases of the menstrual cycle (p < 0.05), when compared to non-PMA asthmatics. Conclusions. The luteal phase of the cycle in PMA patients is associated with increased serum estradiol levels with concurrent higher sputum concentration of IL-5 and IL-8. Serum testosterone levels are decreased, and total number of sputum inflammatory cells is increased in PMA patients in both phases of the menstrual cycle.

Interleukin-17 in sputum correlates with airway hyperresponsiveness to methacholine.

BACKGROUND: Interleukin-17 (IL-17) is a novel cytokine secreted by activated human memory CD4+ T cells. In vivo IL-17 recruits neutrophils into the airways via the release of CXC chemokines (interleukin-8) from bronchial epithelial cells. Since neutrophils are implicated in pathogenesis of chronic obstructive pulmonary disease (COPD) chronic bronchitis (CB) and asthma, we hypothesized that there would be increased concentration of IL-17 in the airways of these patients. To test this hypothesis, we measured levels of IL-17 in induced sputum of COPD patients, chronic bronchitis and asthmatics and compared them with healthy controls. METHODS: Levels of IL-17 in induced sputum were measured via ELISA method in 19 COPD, 16 CB, 10 asthma and 11 control subjects. Airway responsiveness to methacholine was performed in people with FEV1 higher than 70% of predicted. RESULTS: There were no significant differences in IL-17 levels between control group and the other groups. However, levels of IL-17 in sputum of COPD patients were significantly lower than in asthma (P=0.004) and in CB (P=0.01) groups. Medians and (ranges) were as follows: asthma--37.6 pg/ml (18.8-55.7 pg/ml), CB 293 pg/ml (18.8-49.7 pg/ml) and COPD 24.6 pg/ml (0-34.1 pg/ml). Comparison of healthy control subjects (PC20 > 8 mg/ml) to a group with bronchial hyperreactivity, which consisted of asthmatics and CB patients, whose PC20 was less than 8 mg/ml, revealed that levels of IL-17 were significantly increased in the second group (P=0.02). Also, levels of IL-17 were significantly increased (P=0.02) in the asthmatic patients with bronchial hyperreactivity compared to healthy subjects. Moreover levels of IL-17 in sputum of all studied subjects correlated negatively with PC20 (r=-0.51, P=0.002). CONCLUSIONS: According to our results IL-17 is probably not involved in pathogenesis of stable COPD, but it may play a role in people with airway hyperresponsiveness.

[Analysis of occurrence of Chlamydophila pneumoniae infection serological markers in patients with bronchial asthma]. / Analiza wystepowania serologicznych markerów zakazenia Chlamydophila pneumoniae u chorych na astme oskrzelowa.

Numerous publications pointing the role of Chlamydophila pneumoniae infections in etiopathogenesis of bronchial asthma have appeared in recent years. Up to the presence the diagnostics of Chlamydophila pneumoniae infections has been based on the serological examinations especially on indirect microimmunofluorescence which is regarded to be a "gold standard". The aim of the paper was to compare the occurrence of Chlamydophila pneumoniae infection serological markers in the group of patients with asthma (N = 38) and in the control group (N = 38). The obtained results have allowed making the following conclusions: 1. The increased level of IgG class anti-Chlamydophila pneumoniae antibodies in the group of patients with asthma, which proves more frequent contact with Chlamydophila pneumoniae in that group, seems to support the hypothesis about the role of chlamydial infections in etiopathogenesis of bronchial asthma. 2. The single assessment of anti-Chlamydophila pneumoniae antibodies in the ELISA test has not allowed determining the type of chlamydial infection in unambiguous way. However, with reference to the entire clinical picture, the statement of the contact with Chlamydophila pneumoniae can be helpful especially in the treatment of severe asthma.

[Risk factors of venous thromboembolism]. / Czynniki ryzyka choroby zakrzepowo-zatorowej.

Authors discussed the known risk factors of venous thromboembolism (VTE), which is complex disease with two manifestations: deep venous thrombosis (DVT) and pulmonary embolism (PE). Acquired risk factors of VTE are following: age over 40 years, bed rest, surgery, trauma, cancer, myocardial infarction, ischemic stroke, use of oral contraceptives, hormone-replacement therapy, pregnancy and puerperium, previous VTE, long lasting travel and presence of antiphospholipid antibodies. Group of genetic defects predisposing to thromboembolic events are called thrombophilia. The best known causes of thrombophilia are: resistance to activated protein C (factor V Leiden), the prothrombin 20210A, protein C deficiency, protein S deficiency, antithrombin deficiency, hyperhomocysteinemia and abnormality in the fibrinolytic system. Genetic predisposition to thrombosis may be detected in up to one-third of patients with VTER and more than 50% of patients with familial thrombosis. Detection of factor V Leiden is important for patients: with recurrent incidences of VTE, with other known causes of thrombophilia and in members of families with frequent occurrence of VTE. It is important also to detect deficiency of: protein C, protein S and especially of antithrombin in patient with previous VTE, because such patients have 8 to 10 fold increase risk of next incident of VTE. Chronic prevention of thrombosis should be used in all these cases.

[Levels of CC-chemokine (MCP-1 alpha, MIP-1 beta) in induced sputum of patients with chronic obstructive pulmonary disease and patients with chronic bronchitis]. / Stezenia CC-chemokin (MCP-1, MIP-1 alpha, MIP-1 beta) w indukowanej plwocinie u chorych na przewlekla obturacyjna chorobé pluc i u chorych na przewlekle zapalenie oskrzeli.

BACKGROUND: MCP-1, MIP-1 alpha and MIP-1 beta are CC-chemokines, which act as chemoattractants for inflammatory cells like macrophages, lymphocytes and eosinophils. These cells are known to be important for development of chronic obstructive pulmonary disease (COPD) and chronic bronchitis (CB). METHODS: Sputum was obtained from 14 patients with COPD, 12 patients with CB and 14 healthy persons by means of the sputum induction method. The MCP-1, MIP-1 alpha and MIP-1 beta levels were measured in induced sputum via ELISA method. RESULTS: MIP-1 alpha levels in sputum were significantly higher in CB patients compared to healthy persons (p = 0.01). Median and (range) were following: CB patients--22.7 pg/ml (9.2-95.9 pg/ml), control subjects--17.5 pg/ml (0-27.1 pg/ml). The MIP-1 beta levels in sputum were significantly higher in COPD patients compared to healthy persons (p = = 0.003). Median and (range) were following: COPD patients--173.2 pg/ml (30.6-1880 pg/ml), control subjects--19.0 pg/ml (0-570.5 pg/ml). No significant differences were detected among studied groups for MCP-1 levels in induced sputum. There was positive correlation in CB group between levels of MIP-1 beta and number of eosinophils in gram of sputum (r = 0.81 and p = 0.001). CONCLUSIONS: MIP-1 alpha maybe important for development of chronic bronchitis and MIP-1 beta for development of chronic obstructive pulmonary disease. MIP-1 beta is probably a chemoattractant for eosinophils in patients with chronic bronchitis.

[The consequences of sleep structure disturbances in sleep apnea syndrome]. / Nastepstwa zaburzen struktury snu przez zespól bezdechu.

Sleep apnea syndrome (SAS) disturbing the structure of normal sleep causes many diseases. Contemporary studies prove that apnea is an independent risk factor for hypertension and myocardial infarction. Moreover it is emphasized that SAS plays important role in the initiation of arrhythmias, left ventricle dysfunction, pulmonary hypertension, endocrinological disorders and many others. That is the reason of worsened quality of life and increased mortality, mainly as a consequence of cardiovascular complications or high accident rate. Early diagnosis and treatment's application allows to improve the prognosis in these patients. This article recapitulates the knowledge in the field of SAS complications and the potential mechanisms of their development.

[Examination of the pleural effusion and its interpretation]. / Interpretacja wyników rutynowego badania plynu oplucnowego.

Pleural effusion appears in the course of respiratory diseases and disorders of other organs. Examination of the effusion enables differentiation between exudate or transudate. It allows to estimate the severity of the disease, helps to choose the way of treatment and assesses its effects. In most cases Light's criteria are sufficient for differentiation between exudate and transudate. If the patient has an exudative pleural effusion additional tests are indicated to determine the etiology of the effusion. Laboratory tests which are useful in the further diagnostics of pleural effusion include: bacterial cultures, cytological and biochemical tests.

[Clinical picture in sleep apnea syndrome]. / Obraz kliniczny chorych z zespolem bezdechu we snie.

The aim of the study was to assess the clinical picture of patients with sleep apnea syndrome (SAS). The study group consisted of 54 patients (51 men, 3 women) mean age 49.7 +/- 8.7 years, mean body mass index (BMI) 33.1 +/- 5.8. In all cases polisomnography confirmed the diagnosis of SAS. Mean apnea and hypopnea index (AHI) was 66.6 +/- 30.7 and mean minimum arterial blood oxygen saturation was 67.57 +/- 11.58%. It allowed us to qualify 69.4% of patients to the group with a severe SAS. Snoring (93%), apneas (83%), excessive daytime sleepiness (80%), morning weakness (81%), nycturia (66%) were the most common symptoms. The most frequently accompanying diseases in patients with SAS were overweight (89%), depression (67%), arterial hypertension (51%), impaired glucose tolerance (41%).

[Survey of diagnostic methods used in the management of pneumonia]. / Przeglad metod diagnostycznych stosowanych w zapaleniach pluc.

Routine examinations done in patients with pneumonia are following: chest radiograph, Gram stain and culture of sputum. For patients who require hospitalization two sets of blood culture should also be performed. Gram stain and culture of pleural fluid are advised in patients with pleural effusion. Serological testing is important in the diagnosis of atypical pneumonia, but they usually provide retrospective information useful mainly in epidemiological studies. Less frequently used methods are following: bacterial antigen-detection and molecular biology techniques, which may be applied to sputum samples and other biological specimens (pleural fluid, blood, urine etc.). Invasive diagnostic techniques (bronchoalveolar lavage (BAL), protected specimen brush (PSB) or transtracheal aspiration (TTA)) are performed mainly in patients with nosocomial pneumonia especially in critically ill ones. For intubated and mechanically ventilated patients those methods are used to confirm the diagnosis of pneumonia, but for other nosocomial patients the aim is to find causative organism. In spite of higher efficiency of invasive techniques (comparing to non-invasive), one should remember that they may cause dangerous complications and thus before applying them it is necessary to consider if potential benefits overweight risk.

[Bronchial hyperreactivity in chemical plant workers employed in the production of dust pesticides]. / Nadreaktywnosc oskrzeli u pracowników zakladów chemicznych produkujacych pyliste srodki ochrony roslin.

The staff of two chemical plant divisions producing dust pesticides, 131 employees exposed to dust containing 28-65% SiO2 at an average dust concentration of 4.8-5.2 mg/m3 were examined. In the first division (group I, 38 males and 35 females) captan, carbamates, dodine and chlorinated hydrocarbons active substances. In the second division (group II, 26 males and 32 females) the active substances included: carbamates, triazine compounds, cupric oxychloride, captan, lindane, carboxine. Chronic bronchitis was diagnosed in 51.5% of males and 14.9% of females, none had history of asthma. Spirography showed frequent occurrence of impaired maximal endexpiratory flow and elevated residual volume; in about a quarter of the examined subjects a decreased one-second forced expiratory volume was found. The rate of bronchial hyperreactivity to histamine in the examined workers (group I-9.6%, group II-10.3%) did not differ significantly from the control group of 31 healthy inhabitants of the region, professionally unexposed to dust and chemical noxes (6.5%).

[Practical management of nosocomial pneumonia]. / Praktyczne postepowanie w przypadku podejrzenia wewnatrzszpitalnego zapalenia pluc.

Among all nosocomial infections, pneumonia is the second most common (after urinary tract infections) but has the highest mortality rate. Proper antibiotic treatment based on adequate diagnostic methods appears to decrease morbidity and mortality. Practical management of nosocomial pneumonia was shown on graphic diagrams.

[Rational empiric antibiotic therapy of nosocomial pneumonia]. / Racjonalne prowadzenie empirycznej antybiotykoterapii wewnatrzszpitalnych zapalen pluc.

Antibiotic therapy is the method of choice for treatment of nosocomial pneumonia. It can be divided into empiric and specific therapy. First of them is based on predicting potential pathogens which may cause pneumonia. Important factors modifying the choice of initial empiric therapy are following: clinical history (e.g. time in hospital, type of hospital department, prior usage of antimicrobial agents), severity of pneumonia, presence of other risk factors and information given by direct microscopic examination of pulmonary secretions. Based on them it is frequently possible to select group of possible pathogens and then choose effective antibiotics with broad coverage. After a few days when specific etiology is found and antibiogram is performed antibiotic with narrow coverage should replace previous one. Specific therapy possesses several advantages when comparing with empiric therapy. It is more effective and cheaper. But necessity to wait a few days for the result of culture and its relatively low reliability are clear disadvantages.

[The value of studies of quality of life in chronic respiratory tract diseases in the framework of holistic medicine]. / Znaczenie badan jakosci zycia w przewleklych chorobach ukladu oddechowego w aspekcie holistycznego pojecia medycyny.

Quality of Life (QOL) is a new area of research evaluating the psychical, functional and psychological components of human life. According to current understanding of health issues the measurement of morbidity or mortality does not estimate the health status and describe the influence of illness on human life. The theoretical framework of Health Related Quality of Life is largely based on a multidimensional perspective of human as physical, psychological and social functioning and well-being, along the WHO definition of health. QOL assessment could be carried out using different psychological methods. There are several questionnaires developed to assess the quality of life in patients. The measurement instruments are generic (used in wide range of health related issues), domain specific (concerning some important outcome such as social support, coping), and disease specific which are used to assess patients with particular health problems. QOL assessment could be used as the measurements in pharmacoeconomics and clinical trials. Polish QOL Initiative Group produce Polish version of existing questionnaires--for example The Asthma Quality of Life Questionnaire was registered in Polish language version. Quality of Life researches facilitate doctors to understand patient's perceiving of the health state and help them to live a fulfilling life.

[A proposal for management of severe acute bronchial asthma]. / Propozycja postepowania w ciezkim zaostrzeniu astmy oskrzelowej.

The term acute severe asthma has recently replaced status asthmaticus to describe severe asthma attack. Perhaps, this change was associated with better asthma treatment, which prevents currently patients from occurrence of such a severe exacerbation of this disease, to call it status asthmaticus. "Global Initiative for Asthma Global strategy for asthma management and prevention" contains rational guidance on management of this disease, but provide little information about status asthmaticus. This fact was the main reason to prepare present proposal, which was based on suggestion of Global Initiative for Asthma, other current scientific papers and our own experience. We hope that this proposal will begin further discussion, which will bring us closer to more rational solution of this problem.

[Sleep apnea syndrome in patients with diabetes. Effectiveness of treatment for respiratory assistance at night with continuous positive airway pressure]. / Zespól bezdechu we snie u chorych na cukrzyce. Skutecznosc leczenia za pomoca oddychania w nocy powietrzem pod stalym dodatnim cisnieniem.

The group of 30 patients with OSA and diabetes type I or II has been examined. After the first test with MESAM 4, 5 patients with considerable nocturnal desaturation and heart rate disorders during sleep have been found. All diabetes type II. Two polisomnographic studies (the first diagnostic polisomnography and the second study for the settlement of treatment with CPAP) have been performed in the patients. After 6 months of applying CPAP all the patients have been examined again. The apnoea index was decreased (from 87.5 to 11.2) and a better control of both systemic arterial pressure and glycaemia, saturation > 80% has been obtained.

[The significance of viral infection in asthma]. / Znaczenie infekcji wirusowych w astmie.

The aim of the paper was to systematize, according to recent literature data, the processes taking place in respiratory tract in the course of viral infections and to emphasize their relevance to the development of bronchial hyperreactivity and the pathogenesis of asthma. Furthermore, the pathophysiological mechanisms which may be responsible for chronic infection and successively for nonspecific bronchial hyperresponsiveness were reported. Viral pathogens which are suggested to initiate bronchial asthma, its exacerbations and induce dyspnoea were mentioned.

[Clinical aspects of chlamydia respiratory tract infections and their role in the pathogenesis of asthma]. / Kliniczne aspekty chlamydiowych zakazen ukladu oddechowego i ich rola w patogenezie astmy.

Recent world-wide publications were reviewed in order to determine the clinical characteristics and therapeutic relevance of the chlamydial respiratory tract infections in humans. It was emphasized that Chlamydia pneumoniae could initiate asthma and may be associated with acute asthma exacerbation. Laboratory procedures for identifying chlamydia and difficulties concerned with the diagnostics of this intracellular pathogen were also presented. In patients with evidence of chlamydial infection the casual treatment (macrolides, tetracyclines, fluoroquinolones) may induce major improvement or complete resolution of asthma.

[Selected aspects of theophylline antiinflammatory action on the respiratory tract]. / Wybrane aspekty przeciwzapalnego dzialania teofiliny na uklad oddechowy.

Theophylline is now considered not only as the a bronchodilatator, but it is increasingly recognised, that it has other anti-asthma activities. The clinical pharmacological observations and in vitro data showed, that theophylline has several anti-inflammatory activities relevant to asthma. These include, even at low plasma concentrations, the inhibition at cytokine synthesis and release, the inhibition of inflammatory cell activation and microvascular leakage, the prevention of airway hyperresponsiveness induced by airway inflammation. Theophylline appears to have immunomodulatory effects. Theophylline can be regarded as a useful alternative to other anti-inflammatory drugs for the chronic treatment of mild and moderate asthma. It should be used at the lower doses to achieve plasma concentrations of 5-10 mg/l, with will avoid the risk of side effects. Future studies are required to evaluate the role of low-dose theophylline and its place in the management of asthma.

[Nocturnal heart rate variation in patients with sleep apnea syndrome]. / Nocna zmiennosc rytmu serca u chorych z zaburzeniami oddychania podczas snu.

We observed a group of 10 patients with OSA symptoms. In all of them we investigated: the first examination-MESAM 4, EKG, UKG, lung function test, polysomnography. Analyzed the results we regard to appear of the heart rate changes in relation to apnea type, saturation and sleep phases. The results showed, that: 1. The altitude of snoring index is not adequate to the changes of heart rate and altitude of saturation (MESAM 4). 2. Apnea index and desaturation are conformed to heart rate changes (polisomnography). 3. Heart rate changes and desaturations are independent to sleep phases. 4. Heart rate changes and desaturations are independent to apnea type.