Atrial fibrillation independently linked with depression in community-dwelling older population. Results from the nationwide PolSenior project.

BACKGROUND: Depression is a frequently observed comorbid condition in patients with cardiovascular diseases. In contrast to coronary heart disease and heart failure there is a limited amount of published data concerning the increased prevalence of depression among patients with atrial fibrillation (AF). Therefore, we decided to assess the prevalence of depression in Polish community-dwelling older patients with a history of AF. METHODS: The data were collected as part of the nationwide PolSenior project (2007-2012). Out of 4979 individuals (age range 65-104 years), data on self-reported history of AF were available for 4677 (93.9%). Finally, 4049 participants without suspected moderate or severe dementia in Mini Mental State Examination test were assessed with the 15-item Geriatric Depression Scale (GDS), and a score of 6 points and more was regarded as suspected depression. RESULTS: Mean age (±SD) of the study population was 78.1 (±8.3) years; 52% were males. The history of AF was reported by 788 (19.5%) subjects. In the univariate analysis a self-reported AF history was associated with 42% increase of suspected depression (41% vs 29%; P < 0.001). In multivariate logistic regression AF remained an independent predictor of depression (OR = 1.69; 95%CI: 1.43-2.00), stronger than heart failure, diabetes or coronary heart disease. CONCLUSIONS: In community-dwelling geriatric Polish population AF is associated with higher prevalence of depression. This association is independent from the demographic factors, disabilities and comorbidities (including history of stroke).

Prevalence of anemia in relation to socio-economic factors in elderly Polish population: the results of PolSenior study.

Anemia is an independent risk factor for functional decline and mortality among older adults. Since mild anemia in older people is often under-diagnosed and ignored, its prevalence needs precise determination and recognition of predisposing factors. None of the previous studies based on the data obtained from the representative elderly population identified the influence of socio-economic factors on the prevalence of anemia. PolSenior was a cross-sectional population-based study performed on the nationally representative sample of Polish seniors. Complete blood count was assessed in 4003 respondents aged 65 years or above (1910 women) divided into six five-year cohorts and a reference group of 622 people aged 55 - 59 years (333 women). Anemia was defined based on the WHO criteria: Hb < 12.0 g/dL in women and Hb < 13.0 g/dL in men. The following socio-economic factors were evaluated through the multiple logistic regression analysis: education level, marital status, place of residence, living arrangements and self-reported poverty. The prevalence of anemia in older persons standardized for the population was 10.8% (17.4% of the study group) and was more frequent in men than in women (20.8% versus 13.6%). The frequency of anemia progressed with age from 5.3% in the youngest to 37.7% in the oldest cohort, and the progression was higher in men. The multiple logistic regression analysis revealed the link between anemia and age in both genders, as well as unmarried status and urban dwelling in men. When age was not taken into account, logistic regression showed the link between anemia and unmarried status, urban place of residence (both genders), and low level of education (women only). Among seniors, those poorly educated, unmarried and city inhabitants require intense screening for anemia.

Social and economic correlates of malnutrition in Polish elderly population: the results of PolSenior study.

OBJECTIVES: The aim of this study was to evaluate the prevalence of malnutrition in Polish elderly population and analyse its social and economic correlates based on the data from the PolSenior project, the first large-scale study of a representative group of Polish seniors. DESIGN: A cross-sectional population-based study. SETTING: All territorial provinces in Poland. PARTICIPANTS: 4482 community-dwelling respondents aged 65 years or above (women: n=2142, age=79.0±8.4 years; men: n=2340, age= 78.3±8.6 years). MEASUREMENTS: The nutritional status of participants was assessed through the Mini Nutritional Assessment Short Form (the revised MNA-SF). Out of social and economic correlates we evaluated age, sex, level of education, marital status, place of residence, living conditions and economic status. Economic status of the respondents was determined on the basis of questions on how well they could manage their own budgets. Those who could afford only the cheapest food or clothes were considered the group of self-reported poverty. RESULTS: Frequency of malnutrition in the PolSenior population accounted for 7.5% (in 5.0% men and 9.0% women; p<0.001). The risk of malnutrition was present in 38.9% (33.3% men and 42.4% women; p<0.001). In our study female sex, older age, unmarried status, living in a rural area and self-reported poverty were independent correlates of malnutrition. CONCLUSIONS: Our data showed high prevalence of malnutrition and the risk of its development among the community-dwelling elderly people in Poland. Screening with MNA-SF should focus in particular on unmarried, poorly educated individuals, in late old age, living in rural areas and self-reporting a poor financial state, especially women.

Drug consumption among Polish centenarians.

The aim of the study was to describe the quantitative and qualitative aspects of pharmacotherapy of Polish centenarians. The studied group consisted of 92 centenarians (mean age: 101.7±1.2 years, 77 females, mean age: 101.5±1.2; 15 males mean age: 102.2±1.2). Among the studied subjects, 18 individuals (19.6% of all subjects) did not use any drugs in his or her daily regimen. The mean number of drugs per person was 2.5±2.5 drugs (prescription drugs: 1.9±2.2 and non-prescription drugs: 0.5±0.8). Fifty-six centenarians (60.9% of all studied subjects) took concomitantly 0-3 drugs daily while 36 (39.1%) took more than 3 drugs daily. Within this group, 30 centenarians (32.6%) took 5 or more drugs concomitantly every day. The most commonly used groups of drugs were: gastrointestinal drugs (55 centenarians, 74.3% of all drug consumed), cardiovascular drugs (51 centenarians, 68.9%) and central nervous system drugs (N) (38 centenarians, 51.4%). In the studied group, 6 persons (8.1% of all drug consumers) were taking one potentially inappropriate drug based on the Beers criteria. To conclude, the mean number of drugs, the prevalence of polypharmacy, and the tendency for potential inappropriateness of treatment are lower among Polish centenarians comparing to the common elderly.

Blood pressure in centenarians in Poland.

The objective of the study is assessment of the prevalence and type of hypertension in centenarians in Poland. The investigations included 92 people who had turned 100 years of age, who, within the protocol of the Project of Investigation Polish Centenarians, underwent genetic, anthropometric, psychological and sociological examinations, and whose cardiovascular system was assessed. In the present analysis, we are analysing data concerning their blood pressure (BP) assessed by several measurements (3-6) with the mercury sphygmomanometer on both arms in sitting (if possible) or lying position performed during one visit. Hypertension was diagnosed when average BP value exceeded > or = 160/95 or > or = 140/90 mmHg. The average of age was 101.2 years (range 100-111 years), the respective values for BP were: systolic 146.7 mmHg (99-213 mmHg), diastolic BP--80.3 mmHg (55-114 mmHg) and pulse pressure (PP) 66.4 mmHg (31-129 mmHg). Hypertension diagnosed based on the criterion > or = 160/95 mmHg was found in 29% of subjects, and according to the recent WHO criterion (> or = 140/90 mmHg) in 65% of subjects. PP exceeded 65 mmHg in 44.6%, and was above 50 mmHg in 91% subjects. In conclusion, hypertension occurs less frequently in centenarians, than in the entire population of old people, but it nevertheless cannot be considered a rare condition.

[Evaluation of glomerular filtration rate in plasma cell dyscrasias--which test for ambulatory practice?]. / Ocena filtracji klebuszkowej w dyskrazjach komórek plazmatycznych--jaki test w praktyce ambulatoryjnej?

To select the best mathematical formula for ambulatory monitoring of glomerular filtration rate (GFR) in patients with plasma cell dyscrasias (PCD's) we evaluated GFR in 32 pts (22 M + 10 F; mean age 66.1 +/- 9.6) with newly recognized PCD's with the following routine GFR tests: creatinine concentration in serum (Crs); 24 hr's standard creatinine clearance (Crcl) as a reference test; calculation of GFR from Baracskay (BGFR) and Cockcroft-Gault (C-GGFR) formulas. There were: 16 pts without monoclonal proteinuria MP(-) and 16 pts with monoclonal proteinuria MP(+) (0.44-40.3; mean 9.54 g/day). The abnormal values for Crs were defined as > 1.5 mg/dl; for Crcl as < 80.0 ml/min. Only 41% (13/32) of pts had abnormal values of Crs and 84% (27/32) had abnormal values of Crcl. In the group of pts without monoclonal proteinuria MP(-) statistical significance between 24-hr's creatinine clearance and GFR calculated by Cockcroft-Gault as well as Baracskay formulas was not stated. In the group of pts with monoclonal proteinuria MP(+) statistical significance was not stated only between 24-hr's creatinine clearance and GFR calculated by Cockcroft-Gault formula. That was no statistical significance in GFR evaluated with this methods between patients with kappa and lambda monoclonal proteinuria. We concluded, that for ambulatory monitoring of pts with PCD's MP(+) only Cockcroft-Gault formula is recommended. On the other hand pts MP(-) might be monitored using Barasckay as well as Cockcroft-Gault formulas. Because Csr over estimated values of Crcl in both groups of pts, the other serum marker of GFR should be investigated.

[Evaluation of nephrologic "risk" in a newly diagnosed case of plasma cell dyscrasias from personal material (1994-2000)]. / Ocena "ryzyka" nerkowego w swiezo wykrytych przypadkach dyskrazji komórek plazmatycznych w materiale wlasnym (lata 1994-2000).

UNLABELLED: Among 149 patients with recently recognized plasma cell dyscrasia (PCD) in years 1994-2000 72 persons with serologically and nephrologically documented diagnostic profile were selected. In this group of pts we assessed dependence between degree of reduced glomerular filtration rate (GFR), evaluated by serum creatinine concentration and calculated with Barasckay's formula and hypercalcemia, hyperuricemia as well as type of monoclonal protein in urine. RESULTS: We revealed statistically significant higher values of calcium (p = 0.005), uric acid (p = 0.000001) concentrations and higher occurrence of Bence-Jones proteinuria (mainly kappa) in 22 patients with serum creatinine > 1.5 mg/dl in comparison with 50 patients with serum creatinine < or = 1.5 mg/dl. Among 72 patients, GFR > 90 ml/min, calculated with Barasckay's formula, was stated only in 9 patients (12.5%). There was no difference in nephrotoxity between kappa and lambda light chains with reference to serum creatinine concentration and GFR. The group of 12 patients with light chain dyscrasia (LCD) had higher degree of nephrotoxicity in comparison with other forms of PCD. On the basis of our study we concluded that patients with clinical suspicion of PCD, especially those with LCD are referred to a special Protein Laboratory too late, it means at the time of significant nephrological risk in the form of low glomerular filtration rate, hypercalcemia and hyperuricemia.

[Diagnostic and therapeutic problems in primary antiphospholipid syndrome]. / Problemy diagnostyki i leczenia pierwotnego zespolu antyfosfolipidowego.

The purpose of the paper is to estimate clinical problems of the primary antiphospholipid syndrome in a woman presenting recurrent fetal losses, thrombocytopenia, thrombo-embolic disorders, presence of lupus anticoagulant factor and high titer of antiphospholipid antibodies in serum. Clinical anamnesis, physical examination and laboratory findings including kidney biopsy excluded the possibility of SLE as a cause of this syndrome. In the perspective of the next pregnancy prophylaxis against pregnancy complication is discussed.

[Gastrointestinal cancer antigen and immunoglobulins G, A, M in patients with head cancer]. / Ocena surowiczych stezen antygenu zoladkowo-jelitowego (Ca 19-9) oraz immunoglobulin G, A, M u chorych z nowotworami zlosliwymi glowy.

The authors present the results of examinations of immunoglobulins A, G, M serum concentrations and of a sensitivity of test of biochemical tumor marker (Ca 19-9) in a group of 35 patients with head malignant tumors. There was a statistically significant increase of immunoglobulins IgA, IgG and decrease of immunoglobulin IgM. We observed statistical correlation between serum concentrations of IgA, IgG and serum concentrations of IgA, IgM. The sensitivity of Ca 19-9 was 23% in the preliminary study. The values of Ca 19-9 changed in monitoring of tumors to 26%. There was a statistically significant correlation between sensitivity of Ca 19-9 and serum concentration of IgM. We did not observe any statistical correlation between Ca 19-9 and the age of patients.

[Echocardiographic evaluation of cardiac structures in patients with rheumatoid arthritis]. / Ocena echokardiograficzna struktur serca u chorych na reumatoidalne zapalenie stawów.

Since heart lesions were found at autopsy in 55-60% of rheumatoid arthritis patients, we decided to assess echocardiographically their clinical significance. The study comprised 100 consecutive patients with rheumatoid arthritis (77 females and 23 males) of the mean age 55.7 +/- 12.5 yrs (range 18-83 yrs) and the disease duration of 8.3 +/- 8.0 yrs (range 1-35 yrs). The control group consisted of 100 consecutive age and sex matched patients admitted to university hospital. All the patients underwent echocardiographic examinations in apical and parasternal projections. The activity of the rheumatoid process, the severity of articular lesions, the presence of extraarticular sings as well as HLA DR and DQ antigens were determined clinically and with laboratory tests. Twenty six patients with rheumatoid arthritis had pericardial effusion, 10 revealed the sings of chronic pericarditis, in the control group 4 and 0 respectively (p = 0.001 and p = 0.025). No difference was shown in the wall contractions disturbances, size of the cardiac cavity, or thicknesses of the interventricular septum or posterior wall. In 3 rheumatoid arthritis patients, a valvular heart disease was diagnosed, this number was not significantly different from that in the control group (2 patients). There was no correlation between the lesions observed in the heart and the rheumatoid process activity estimated with clinical and laboratory indices.

[Subcutaneous immunoglobulin infusion in antibody deficiency substitution of a patient sensitized to intravenous immunoglobulins. Case report]. / Podskórne infuzje immunoglobulin w substytucji niedoboru przeciwcial u chorej uczulonej na immunoglobuliny dozylne. Opis przypadku.

Patients with severe form of common variable immunodeficiency require chronic immunoglobulin substitution. However, intravenous Ig administration may not be possible in some of them because of serious anaphylactoid reactions. It has been suggested that such patients may tolerate well Ig administration by subcutaneous infusion. A case is described (originally with IgG level of 53 mg/dl) who reacted with anaphylactic shock to intravenous immunoglobulin and now for more than 7 months at 1-2 week intervals receives immunoglobulin by subcutaneous infusion without any adverse reactions and maintaining IgG level above 400 mg/dl. In contrast to the period proceeding immunoglobulin substitution, the patient remains free of bacterial infection during last 7 months.

24-h ECG monitoring in patients with rheumatoid arthritis.

Although the main cardiac complication in patients with rheumatoid arthritis is subclinical pericarditis, mononuclear cell infiltrations into myocardium may cause cardiac arrhythmias and conduction defects. In order to examine these problems we evaluated 70 patients (53 women and 17 men) aged 18-83 years (average 56.7 +/- 11.2) with classic or definite rheumatoid arthritis, according to diagnostic criteria. Duration of the disease was 1-35 years (average 8.7 +/- 8.4). The control group comprised 70 patients admitted to hospital with degenerative joint disease, a duodenal ulcer, or who required treatment for ophthalmological or laryngeal reasons; these patients were matched for sex and age. In all patients standard 12-lead ECG investigations were performed, as well as 24-h ECG monitoring, using an Oxford Medical System device with two precordial leads CM5 and CS2, according to the Holter method. We analysed heart rate, conduction disturbances, and occurrence of arrhythmias, on the basis of generally assumed ECG criteria. Cardiac arrhythmias were found in 50% of patients with rheumatoid arthritis, and their occurrence was similar to that in the control group. Observed arrhythmias were independent of the progression of arthritis, the type of treatment administered, the familial occurrence of arthritis, the presence of manifestations pertaining to organs, the presence of rheumatoid factor, the stage of the disease according to Steinbrocker, or the presence of immune complexes in serum and HLA Dr antigens, which are regarded as fundamental in the pathogenesis of rheumatoid arthritis.

[Evaluation of the differences in levels of immunoglobulin G, A,and M in the course of malignant head and neck tumors]. / Ocena róznic stezen immunoglobulin G, A, i M w przebiegu nowotworów zlosliwych glowy i szyi.

Serum levels of a variety of substances shows significant changes in head and neck cancer patients. IgG, IgA, IgM were examined in 100 patients with the head and neck cancer. Serum levels of IgG, IgA and IgM were different in variety localisation of the primary tumor. In patients with head and neck cancer medium serum levels of IgG and IgA were elevated but serum level of IgM was normal. Medium serum levels of IgG and IgA were higher in patients with another cancer than larynx cancer. Medium serum levels of IgM were highest in patients with larynx cancer.

Frequency and significance of the major and minor features of Hanifin and Rajka among patients with atopic dermatitis.

In 481 patients with atopic dermatitis (AD), 4 major features of Hanifin and Rajka were found in 72%, and in 96% over 6 minor features were seen, which is much more than the minimum required by these authors for making a 'firm diagnosis'. The incidence of particular minor features in all patients was varying significantly, and in subgroups of patients they appeared with different frequency. For example, asthma occurred more often in AD patients with the onset of skin lesions before the 6th month of life, and food intolerance was more frequently observed in patients with very high serum IgE level. In the control groups some minor features also occur but less frequently than in AD patients. We conclude that the anterior neck folds and Dennie-Morgan infraorbital fold should be regarded as minor AD features.

High serum levels of allergen specific IgG-4 (asIgG-4) for common food allergens in healthy blood donors.

High serum levels of asIgG-4 against common food allergens are found in many patients with symptoms suggesting food allergy. The same patients are frequently negative for allergen specific IgE (asIgE) against the same allergens. These data were frequently interpreted as suggestive of a role of asIgG-4 in food allergy. In order to evaluate this hypothesis we tested serum levels of asIgG-4 against food allergens in young blood donors without any signs or history of food allergy. Fifty young healthy male donors were evaluated. The serum levels of IgE, and asIgE and IgG-4 against 14 common food allergens were determined. The studies were carried out using commercially available 3M Diagnostics Systems kits. AsIgG-4 against food allergens were found in sera of 92% blood donors, and in 62% of these healthy persons the levels of asIgG-4 were higher than 10.0 micrograms/ml. In a small proportion of patients, high serum levels of IgE and asIgE against the same food and/or inhalant allergens were found. Common occurrence of asIgG-4 against food allergens in healthy persons (without any symptoms which could suggest allergy or food intolerance) argues against the possible participation of these antibodies in the pathogenesis of food allergy. It is possible that their occurrence is the result of immunization against food antigens (allergens). It remains to be resolved whether the presence of these antibodies represents an epiphenomenon or may have some other biological role.

Allergen-specific IgG-4 in patients with atopic diseases of the respiratory tract.

Serum levels of total IgE, allergen-specific IgE (asIgE) and allergen-specific IgG-4 (asIgG-4) were measured in 194 patients in whom atopic disease of respiratory tract was suspected. The patients were divided into 8 groups based on the results of skin testing and sera levels of IgE and asIgE. Increase of the serum asIgG-4 level was observed in only 26 cases (13%), and occurred exclusively in patients with positive skin reactions to allergen(s) accompanied by increased serum levels of asIgE. In contrast, no significant elevation of serum asIgG-4 was found in non-atopic patients and in patients in whom skin testing and serologic evaluation did not yield conclusive results. These results argue against involvement of asIgG-4 antibodies in the pathogenesis of atopic diseases and against their function as sensitizer of target cell, analogous to the function of asIgE. In the present study elevated level of serum asIgG-4 was noted predominantly in asthmatic patients previously subjected to specific desensitization, that is to repeated exposure to antigen (allergen), which could induce specific antibody response. It is in agreement with the notion, that the appearance of asIgG-4 antibodies in sera of the patients under study is a consequence of the specific immunization, and not of atopy.