Kidney volume normative values in Central European children aged 0-19 years: a multicenter study.

BACKGROUND AND OBJECITVES: The currently available kidney volume normative values in children are restricted to small populations from single-centre studies not assessing kidney function and including none or only a small number of adolescents. This study aimed to obtain ultrasound-based kidney volume normative values derived from a large European White/Caucasian paediatric population with normal kidney function. METHODS: After recruitment of 1427 children aged 0-19 years, 1396 individuals with no history of kidney disease and normal estimated glomerular filtration rate were selected for the sonographic evaluation of kidney volume. Kidney volume was correlated with age, height, weight, body surface area and body mass index. Kidney volume curves and tables related to anthropometric parameters were generated using the LMS method. Kidney volume predictors were evaluated using multivariate regression analysis with collinearity checks. RESULTS: No clinically significant differences in kidney volume in relation to height were found between males and females, between supine and prone position and between left and right kidneys. Males had, however, larger age-related kidney volumes than females in most age categories. For the prediction of kidney volume, the highest coefficient correlation was observed for body surface area (r = 0.94), followed by weight (r = 0.92), height (r = 0.91), age (r = 0.91), and body mass index (r = 0.67; p < 0.001 for all). CONCLUSIONS: This study presents LMS-percentile curves and tables for kidney volume which can be used as reference values for children aged 0-19 years.

Kidney length normative values - new percentiles by age and body surface area in Central European children and adolescents.

BACKGROUND: Kidney size evaluation is an essential examination in pediatric nephrology. While body length/height is the best predictor of kidney length, age-based and body surface area (BSA)-based normative values may be useful in clinical practice or research. This study aimed to establish ultrasound-based kidney length lambda-mu-sigma (LMS) percentiles by age and BSA in healthy children. METHODS: In 1758 Polish and Lithuanian children (868 boys, 49%) aged 0-19 years, kidney length was measured using ultrasonography. In all participants, anthropometric measurements were taken and kidney function was evaluated based on serum creatinine concentration. Participants with chronic or kidney diseases, abnormal kidney function, or pathologies in sonographic examination were excluded from the analysis. RESULTS: Kidney length (median kidney length) increased progressively from infancy to the age of 18 years, from 60.1 to 114.2 mm in males, and from 57.3 to 105.2 mm in females. A gradual increase of kidney length (50th percentile) in relation to BSA (from 46.1 mm in infants with a BSA of 0-1.2 m2 to 118.3 mm in adolescents with a BSA of 2.6-2.8 m2) was also observed. LMS percentiles by age (stratified by sex) and BSA were determined and presented as graphs and tables of percentiles and LMS parameters by 1-year age intervals and 0.2 m2 of BSA, respectively. CONCLUSIONS: We present the first age- and BSA-based kidney length LMS normative values based on the largest pediatric cohort to date, which can be used in both clinical practice and research studies. A higher resolution version of the Graphical abstract is available as Supplementary information.

Kidney length normative values in children aged 0-19 years - a multicenter study.

BACKGROUND: Currently used pediatric kidney length normative values are based on small single-center studies, do not include kidney function assessment, and focus mostly on newborns and infants. We aimed to develop ultrasound-based kidney length normative values derived from a large group of European Caucasian children with normal kidney function. METHODS: Out of 1,782 children aged 0-19 years, 1,758 individuals with no present or past kidney disease and normal estimated glomerular filtration rate had sonographic assessment of kidney length. The results were correlated with anthropometric parameters and estimated glomerular filtration rate. Kidney length was correlated with age, height, body surface area, and body mass index. Height-related kidney length curves and table were generated using the LMS method. Multivariate regression analysis with collinearity checks was used to evaluate kidney length predictors. RESULTS: There was no significant difference in kidney size in relation to height between boys and girls. We found significant (p < 0.001), but clinically unimportant (Cohen's D effect size = 0.04 and 0.06) differences between prone vs. supine position (mean paired difference = 0.64 mm, 95% CI = 0.49-0.77) and left vs. right kidneys (mean paired difference = 1.03 mm, 95% CI = 0.83-1.21), respectively. For kidney length prediction, the highest coefficient correlation was observed with height (adjusted R2 = 0.87, p < 0.0001). CONCLUSIONS: We present height-related LMS-percentile curves and tables of kidney length which may serve as normative values for kidney length in children from birth to 19 years of age. The most significant predictor of kidney length was statural height.

Spicae aetheroleum in uncomplicated acute bronchitis: a double-blind, randomised clinical trial.

BACKGROUND: The trial aimed to evaluate the efficacy and safety of Spicae aetheroleum (Spicae ae.), a phytomedicine obtained by steam distillation of the flowering tops of Lavandula latifolia, as compared to placebo in adult patients with acute bronchitis. METHODS: Patients with uncomplicated acute bronchitis (bronchitis severity score [BSS] ≥ 5 score points) were randomly assigned to treatment with Spicae ae. or placebo in a double-blind, parallel-group design. No additional treatment was admitted. The primary objective was the mean difference of a defined total BSS of 25% between the Spicae ae. and the placebo group after 7 days of full medication dose. Secondary endpoints included the BSS at day 10, additional signs and symptoms of bronchitis, quality of life (QoL) and safety. RESULTS: The mean decrease in BSS at day 7 and day 10 was significant with 4.79 vs. 3.20 (p < 0.005 for a 25% difference) and 6.47 vs. 4.32 (p < 0.009 for a 25% difference) score points respectively in the Spicae ae. (n = 119) vs. placebo group (n = 110). Accordingly, most additional signs and symptoms of acute bronchitis as well as the patients' QoL improved significantly with Spicae ae. as compared to placebo. In all, 258 patients were eligible for safety analysis. The treatment with Spicae ae. was well tolerated; no serious adverse events occurred. CONCLUSION: The defined objectives both for the primary and secondary endpoints have been met. The results of this study provide evidence that Spicae ae. is well tolerated, effective and superior to placebo in the symptomatic treatment of uncomplicated acute bronchitis in adult patients.

Visceral adiposity index as a useful tool for the assessment of cardiometabolic disease risk in women aged 65 to 74.

BACKGROUND: The visceral adiposity index (VAI) is considered to be a reliable indicator of adipose tissue dysfunction and cardiometabolic disease risk. The aim of this study was to evaluate its usefulness in assessing cardiometabolic risk in a sample of elderly women living in a rural-urban community in central Poland. METHODS: A total of 365 women aged 65 to 74 years were included in this cross-sectional study. All patients were interviewed to obtain their history of diabetes mellitus, myocardial infarction, stroke, and revascularization. For all participants, anthropometric measurements were performed, then body mass index (BMI) and waist/hip ratio were calculated. Blood pressure was measured on the arm and on both ankles, and the ankle/brachial index was calculated. Blood samples were collected for the assessment of glycemia, lipid profile, and creatinine level. In patients with elevated fasting glucose, the test was repeated, or an oral glucose tolerance test was performed where appropriate. Finally, carotid intima-media thickness was measured in all women. RESULTS: The VAI of participants was significantly correlated with a history of myocardial infarction, higher carotid intima-media thickness, diabetes, prediabetes, and impaired kidney function. Furthermore, VAI demonstrated a better correlation with these endpoints than BMI or waist circumference. CONCLUSIONS: The VAI can be considered a useful tool for the assessment of cardiometabolic disease risk in elderly women, with a score of ≥2.71 representing the cut-off point for identifying females at high risk. In such patients, screening for cardiovascular disease, abnormal glucose metabolism, and impaired kidney function should be routine practice.

Risk factors for cancer development in type 2 diabetes: A retrospective case-control study.

BACKGROUND: The risk of several types of cancer is increased in type 2 diabetes mellitus. The earliest possible diagnosis of cancer - difficult within regular outpatient diabetes care - is of utmost importance for patients' survival. The aim of this multicenter, retrospective (years 1998-2015), case-control study was to identify risk factors associated with malignancy in subjects with diabetes treated in a typical outpatient setting. METHODS: In the databases of 3 diabetic and 1 primary care clinics 203 patients (115 women) with type 2 diabetes mellitus who developed malignancy while treated for diabetes were identified. The control group consisted of 203 strictly age- and gender matched subjects with type 2 diabetes without cancer. Factors associated with diabetes: disease duration, antidiabetic medications use and metabolic control of diabetes were analyzed. Also other variables: BMI (body mass index), smoking habits, place of residence and comorbidities were included into analysis. RESULTS: The most prevalent malignancies in men and women together were breast cancer (20.7 %) and colorectal cancer (16.3 %). HbA1c (hemoglobin A1c) level ≥8.5 %, obesity and insulin treatment in dose-dependent and time-varying manner demonstrated significant association with increased risk of malignancy, while metformin use was associated with a lower risk of cancer. Diabetes duration, comorbidities, smoking habits, place of residence and aspirin use did not show significant association with risk of malignancy. CONCLUSIONS: In the outpatient setting the obese patients with poorly controlled insulin treated type 2 diabetes mellitus should be rigorously assessed towards malignancies, particularly breast cancer in women and colorectal cancer in men.

Accelerated vascular age in adolescents with primary hypertension.

BACKGROUND: Primary hypertension may lead to early vascular ageing. We aimed to evaluate differences between expected vascular age based on pulse wave velocity (PWV)/carotid intima-media thickness (cIMT) and actual chronological age (CHA) in adolescents with primary hypertension. METHODS: Three hundred and fifty-two children (median age of 15.5 years) with office hypertension and 64 normotensive healthy children of the same age underwent anthropometry, office and ambulatory blood pressure (BP), left ventricular mass index, cIMT, PWV, pulse wave analysis and biochemistry measurements. Vascular age was calculated using pooled pediatric and adult normative PWV and cIMT data. The difference between vascular age and CHA was calculated in relation to the 90th percentile for PWV (PWVAgeDiff90) and the 95th percentile for cIMT (cIMTAgeDiff95). RESULTS: One hundred and sixty-six patients had white-coat hypertension (WCH), 32 had ambulatory prehypertension (AmbPreHT), 55 had isolated systolic hypertension with normal central SBP (ISH+cSBPn), 99 had elevated office, ambulatory and cSBP (true hypertension, tHT). The differences between vascular age (both PWV and cIMT based) and CHA were significantly higher in AmbPreHT and tHT compared with normotension, WCH and ISH+cSBPn. Median PWVAgeDidff90 was -3.2, -1.2, -2.1, +0.8 and +0.3 years in normotension, WCH, ISH+cSBPn, AmbPreHT and tHT, respectively. Median cIMTAgeDiff95 was -8.0, -6.3, -6.8, -3.8 and -4.3 years in normotension, WCH, ISH+cSBPn, AmbPreHT and tHT, respectively. Significant predictors of PWVAge90Diff were the DBP and serum cholesterol, whereas cSBP and augmentation index were significant predictors of cIMTAgeDiff95. CONCLUSION: Children with AmbPreHT and tHT show accelerated vascular age compared with their normotensive peers.

Abdominal aorta diameter as a novel marker of diabetes incidence risk in elderly women.

The prevalence of diabetes mellitus is increasing worldwide, including the nation of Poland. The aim of this prospective and observational study was to determine risk factors and the predictors of diabetes incidence in elderly women, and to calculate the diabetes incidence ratio in this population. Two-hundred women, aged 65-74, who were non-diabetic at baseline in 2012 were followed for 6.5 years. All women were checked for incident diabetes. In non-diabetic subjects, diagnostic procedures for diabetes were performed according to Poland's Diabetes recommendations. Between April 2012 and September 2018, 25 women developed diabetes and the next 11 cases were diagnosed based on FPG or oral glucose tolerance test. Women with incident diabetes had significantly higher baseline FPG, triglycerides (TG), TG/HDL cholesterol ratio and visceral adiposity index (VAI) score, and lower abdominal aorta diameter (AAD), HDL cholesterol and eGFR. In the Cox proportional hazard regression analysis, only AAD < 18 mm and VAI score ≥ 3.8 were independently associated with diabetes risk, hazard ratio (HR) 2.47 (95% confidence interval 1.21-5.02), P = 0.013 and HR 2.83 (1.35-5.94), P = 0.006 respectively. In the backward stepwise regression analysis including all variables, diabetes incidence could be predicted from a linear combination of the independent variables: AAD < 18 mm (P = 0.002), VAI score ≥ 3.8 (P < 0.001) and FPG ≥ 5.6 mmol/L (P = 0.011). The calculated incidence of diabetes was 2769.2 new cases/100,000 persons per year. AAD below 18 mm seem to be a novel, independent marker of diabetes risk in elderly women, and AAD assessment during routine abdomen ultrasound may be helpful in identifying females at early elderliness with high risk of diabetes incidence.

Hemodynamic Patterns and Target Organ Damage in Adolescents With Ambulatory Prehypertension.

Although the importance of office prehypertension/high normal blood pressure (BP) has been well documented, the significance of ambulatory prehypertension (AmbPreHT) has not been determined. We analyzed markers of target organ damage and hemodynamics in adolescents with AmbPreHT in comparison with hypertensive and normotensive subjects. Out of 304 white patients aged 15.0±2.5 years with office hypertension, 30 children had AmbPreHT and were compared with 66 normotensive healthy children and 92 children with true hypertension (elevated office, ambulatory, and central BP), 22 had ambulatory hypertension (AmbHT), and 70 had severe AmbHT (SevAmbHT). Stroke volume and cardiac output were greater in AmbPreHT compared with patients with normotension but did not differ between AmbPreHT, AmbHT, and SevAmbHT. Similarly, AmbPreHT, AmbHT, and SevAmbHT had similar total peripheral resistance, lower than patients with normotension (P<0.05). Central systolic BP was higher in patients with AmbPreHT, AmbHT, and SevAmbHT compared with normotensives (P<0.01). In all 3 groups, the carotid intima-media thickness Z scores were significantly higher than in normotensive (P<0.001). AmbPreHT and AmbHT patients had higher left ventricular mass index and prevalence of left ventricular hypertrophy compared with normotensive but lower compared with SevAmbHT (P<0.001). Pulse wave velocity Z scores were increased in patients with AmbPreHT, AmbHT, and SevAmbHT compared with patients with normotension (P<0.01). Multiple regression analysis showed that body mass index Z score, central systolic BP, and uric acid levels were significant independent predictors of left ventricular mass index. In conclusion, patients with AmbPreHT presented similar cardiovascular adaptations to those observed in patients with hypertensive and may be at risk of developing cardiovascular events.

Impact of orthostatic hypotension and antihypertensive drug treatment on total and cardiovascular mortality in a very elderly community-dwelling population.

OBJECTIVE: The aim of this study was to examine the relationship between orthostatic hypotension, cardiovascular drug intake and mortality in a very elderly community-dwelling population (>80 years of age). METHODS: In 2013-2014, 224 (71 M, 31.7%) 80-year-old individuals from one primary care practice were invited to participate. Basic clinical information was gathered and blood pressure (BP) measurements were performed while sitting and after 1 and 3 min in the standing position on 209 patients. The individuals were followed till December 2016. RESULTS: Orthostatic hypotension was present, depending on applied definition, in 34.5% of the individuals at 1 min, 38.3% at 3 min; 44.9% on either 1 or 3 min, and 27.8% individuals in both measurements. Sixty-nine (30.8%) individuals died during the follow-up. Presence of orthostatic hypotension, irrespective of definition, did not have any significant association with the mortality risk in all groups. Intensive hypertension treatment (more than two drugs versus none) was associated with longer survival. In a multivariate logistic regression analysis, only age and presence of coronary heart disease/congestive heart failure had a negative predictive value on mortality. In both treated and untreated individuals, presence of orthostatic hypotension was not linked to mortality. CONCLUSION: Although orthostatic hypotension is very common among the very elderly, its presence is not related to increased risk of death (all-cause/cardiovascular). Intensively treated elderly patients had significantly longer survival time than untreated individuals.

Reduced weight gain with insulin detemir compared to NPH insulin is not explained by a reduction in hypoglycemia.

BACKGROUND: Weight gain often occurs when insulin therapy is initiated. The long-acting insulin analog insulin detemir has been shown to be effective and well tolerated when used in basal-bolus regimens or as an add-on to oral antidiabetic drugs (OADs) and causes less weight gain than other insulins. The aim of this exploratory analysis was to investigate any correlations between weight change and occurrence of hypoglycemia with NPH insulin and insulin detemir. METHODS: The analysis was based on a 26-week, randomized, multicenter, open-label, parallel-group trial in which glycemic control, hypoglycemia, and weight change were compared between insulin detemir and NPH insulin. A total of 476 insulin-naive patients with type 2 diabetes treated with one or two OADs added insulin detemir (n=237) or NPH insulin (n=239) morning and evening to their current oral treatment. Weight gain data from this study were analyzed as a function of hypoglycemia frequency. RESULTS: Both groups achieved excellent glycosylated hemoglobin control (insulin detemir, 6.6%; NPH insulin, 6.5% [difference not significant]). Weight gain with insulin detemir was less than half that of NPH insulin (1.2 vs. 2.8 kg, respectively [P<0.001]), and the overall risk of hypoglycemia was 47% lower with insulin detemir (P<0.001). No significant relationship between hypoglycemia and weight gain was seen with insulin detemir (P=0.2), while a statistically significant correlation was found for NPH insulin (P=0.003). CONCLUSIONS: Hypoglycemia is predictive of weight gain with NPH insulin, but the same relationship is not seen with insulin detemir. It is therefore likely that the weight-sparing effect of insulin detemir involves other mechanisms.

Association between Fasting Glucose Concentration, Lipid Profile and 25(OH)D Status in Children Aged 9⁻11.

BACKGROUND: The aim of this study was to assess the relationship between vitamin D status and the prevalence of dyslipidemia and impaired fasting glucose (IFG) in children. Methods and Summary: 284 children (150 boys and 134 girls) aged 9⁻11 were included in the study. Children with deficient 25(OH)D (25-hydroxycholecalciferol) levels ≤20 ng/mL (50 nmol/L) were characterized by a more frequent occurrence of impaired fasting glucose (IFG) (Odd ratios (OR) = 1.966, 95% confidence interval (CI): 1.055⁻3.663; p = 0.033) when compared to children with 25(OH)D >20 ng/mL. Serum 25(OH)D with concentration lower by 1 ng/mL (2.5 nmol/L) was linked to higher fasting glucose (by 0.25 mg/dL, 0.013 mmol/L; p = 0.017), higher total cholesterol (TC) by almost 1 mg/dL (0.96 mg/dL, 0.25 mmol/L; p = 0.006) and higher high-density lipoprotein cholesterol (HDL-C) (by 0.57 mg/dL, 0.015 mmol/L; p < 0.001). CONCLUSION: 25(OH)D deficiency may negatively affect fasting glucose and total cholesterol concentration in children aged 9⁻11. Vitamin D-deficient children are twice as likely to develop prediabetes as reflected by impaired fasting glucose when compared to those with a 25(OH)D level above 20 ng/mL (50 nmol/L).

Non-fasting lipid profile determination in presumably healthy children: Impact on the assessment of lipid abnormalities.

OBJECTIVE: Despite the common use of non-fasting measurements for lipid profile in children it remains unclear as to the extent non-fasting conditions have on laboratory results of lipids measurements. We aimed to assess the impact of non-fasting lipid profile on the occurrence of dyslipidemia in children. MATERIALS AND METHODS: Basic lipid profile including: total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG), as well as small, dense-LDL-C (sd-LDL-C), apolipoprotein AI (ApoAI), apolipoprotein B (ApoB) and lipoprotein(a) [Lp(a)], were measured in 289 presumably healthy children aged 9-11 in both fasting and non-fasting condition. The clinical impact of non-fasting lipid profile was evaluated individually for each child with estimation of false positive (FP) and false negative (FN) results. RESULTS: The highest percentage of FP results in non-fasting condition was observed for TG (42.3%) being significantly higher when compared to FN results (p = 0.003). In contrast, the highest percentage of FN results in a non-fasting state were shown for LDL-C (14.3%), but the difference was statistically insignificant when compared to FP results. When comparing fasting and non-fasting lipid profile a number of significant differences was shown for: TG (p<0.001), HDL-C (p = 0.002) LDL-C (p<0.001) and ApoAI (p<0.001), respectively. The occurrence of dyslipidemia, recognized on the basis of non-fasting lipids was significantly higher (p = 0.010) when compared to fasting lipid profile. CONCLUSIONS: A higher occurrence of dyslipidemia, based on the measurement of non-fasting lipids in children, is suggestive of possible disorders in lipid metabolism. However, accurate identification of dyslipidemia by assessment of non-fasting lipids requires the establishment of appropriate cut-off values for children.

Prevalence and characteristics of OSAFED syndrome in atrial fibrillation primary care patients.

BACKGROUND: Atrial fibrillation (AF) constitutes the most prevalent arrhythmia, affecting up-to 2% of the general population. Apart from well-established risk factors that increase the odds for the development of AF, e.g. age or arterial hypertension, recent analyses indicate that obstructive sleep apnoea (OSA) may independently, negatively modify the arrhythmia occur-rence profile. Concurrently, erectile dysfunction (ED) is a commonly neglected, potent marker of cardiovascular risk, which considerably worsens men's psychological state. Unrecognised or untreated ED results in substantial deterioration of the patient's therapeutic programme adherence. Because AF, OSA, and ED share multiple risk factors and clinical consequences, in 2013 the concept of their frequent concurrence - OSAFED syndrome - was proposed. AIM: The aim of the study was to evaluate the prevalence of OSAFED patients with AF in primary care practice. METHODS: Retrospective analysis was carried out of data from primary care physician charts (NZOZ Esculap Gniewkowo, central Poland) including 1372 men aged 40-65 years. The primary goal was to determine the diagnosis of paroxysmal and/or perma-nent AF, which was followed by sleep apnoea screening (polygraphy) and erectile function evaluation (IIED-5 questionnaire). RESULTS: Twenty-one (1.5%) patients with documented AF were identified. Based on the sleep-polygraphic studies, 14 (67%) of them had confirmation of OSA with mean apnoea-hypopnea index (AHI) equal to 27.5 ± 17.1. Furthermore, 11 (52%) patients met the OSAFED syndrome criteria. Patients with OSAFED syndrome had a mean score in IIEF-5 of 11.6 ± 3.5. The OSAFED-patients who were not diagnosed with all the of the syndrome components prior to the study-enrolment were characterised by substantially lower fat excess compared to their counterparts with already established OSAFED (body mass index: 30.1 ± 4.9 vs. 37.7 ± 3.9 kg/m², respectively, p = 0.03). CONCLUSIONS: Frequently coexisting OSAFED syndrome components in all AF patients from the primary care setting should encourage a more active search for OSA and ED in patients with any documented form of AF. Most of the studied patients did not have the diagnosis of OSA nor ED done prior to participation in the study.

Differences in risk factors of malignancy between men and women with type 2 diabetes: A retrospective case-control study.

BACKGROUND: The aim of this multicenter, retrospective, case-control study was to identify differences in risk factors of malignancy between men and women with type 2 diabetes. RESULTS: Among women the most prevalent malignancies were: breast and uterine cancers (35.6% and 14.4% respectively), while among men there were: colorectal and prostate cancers (24.5% and 13.3% respectively). In both gender metformin use was associated with lower cancer risk. Obesity and insulin treatment in dose-dependent and time-varying manner were associated with significantly increased risk of malignancy in females. In men, unexpectedly, cardiovascular disease was more prevalent in control group. Other variables did not show significant association with malignancy risk. MATERIALS AND METHODS: 118 women and 98 men with type 2 diabetes mellitus who developed cancer after diagnosis of diabetes and the same number of strictly age matched controls with type 2 diabetes and without malignancy were included into the study. Diabetes duration, antidiabetic medications use, glycated hemoglobin level, body mass index, smoking habits, occupation, presence of comorbidities and aspirin use were included into analyses. CONCLUSIONS: Metformin demonstrated protective effect against cancer in both sexes. Obesity and insulin treatment seem to have greater impact on cancer risk among women.

Cross-sectional study of the ankle-brachial index and cardiovascular risk factors in postmenopausal women.

BACKGROUND: The incidence of peripheral artery disease (PAD) and cardiovascular (CV) events in the female population has been on the increase. AIM: To analyse the risk factors of a CV event and PAD in women and to assess the usefulness of the ankle-brachial index (ABI). METHODS: Evaluation of selected parameters in a cohort of 365 women living in the same district. The following data were prospectively recorded: weight, height, waist size, hip circumference, smoking, the intima-media complex, ABI value, and laboratory results. PAD symptoms, CV events and neurological events were noted. ABI was analysed assuming pathology for values: ≤ 0.9 or ≤ 1.0. RESULTS: Age, plasma glucose level, atrial fibrillation, and nicotine addiction were correlated independently with CV disease and stroke (p < 0.001). The high-density lipoprotein cholesterol level, height, and systolic blood pressure were correlated independently with ABI values (p < 0.05). There was no correlation between the occurrence of a CV event in the past and the ABI, irrespective of the cut-off point for the reference value (p = NS). CONCLUSIONS: There is no evidence that stricter criteria for the assessment of ABI better represent the vascular status in the female population.

The prevalence of abdominal aortic aneurysms in the rural/urban population in central Poland - Gniewkowo Aortic Study.

BACKGROUND AND AIM: Abdominal aortic aneurysm (AAA) is a widening of the aorta below the renal arteries with a diameter equal to or greater than 3 cm. The prevalence of AAA is estimated at 4-8% in men aged 65 years or older and 1-2% among women over 65 years old. Participation in screening programmes has decreased the number of aortic ruptures. METHODS: All men aged 60 years and older, and women aged 65 years and older living in the rural/urban commune in central Poland were invited to participate in the study. In total 922 persons (61% of the invited population) entered the study. The men were divided into two groups: 60-64 years old, and 65 years and older. Screening abdomen ultrasound was performed and demographic data was collected. RESULTS: Among the 922 examined persons two (1.01%) AAAs were diagnosed in the group of men 60-64 years of age, three (0.82%) AAAs amongst women ≥ 65 years old, and 33 (9.29%) AAAs were found in the group of men aged 65 years and older. A positive relationship between the presence of AAA and smoking (p = 0.0048), age of men (p = 0.0009), and history of myocardial infarction/acute coronary syndrome (MI/ACS) (p = 0.0079) was found. There was no correlation between the frequency of AAA and diabetes mellitus (p = 0.46), hypertension (p = 0.38), and family history of AAA (p = 0.44). CONCLUSIONS: The prevalence of AAA in men aged 65 years and older is seemingly larger than in previously conducted studies, while among men 60-64 years of age and women aged ≥ 65 it is similar. Older age, smoking, and a history of MI/ACS were the most important risk factors of AAA occurrence.

Association of anthropometric measures of obesity and chronic kidney disease in elderly women.

INTRODUCTION AND OBJECTIVE: Growing evidence suggests that obesity is an important contributor to the development of chronic kidney disease (CKD). The relationship between obesity and CKD is complex and not completely understood, and the best anthropometric index of obesity in predicting CKD is controversial. This study aimed to determine the best anthropometric index of obesity in predicting CKD in a population of elderly women. MATERIALS AND METHODS: Anthropometric indexes of obesity including body mass index (BMI), waist circumference (WC), waist-to-height ratio (WheiR) and waist-to-hip-ratio (WHR), were obtained in 730 selected females. Biochemical measurements including blood glucose, lipid profile, and 2-h postprandial blood glucose were performed. GFR was estimated by using CKD-EPI equation. RESULTS: The prevalence of CKD stage ≥ 3 was 12.2%. Overweight and obesity was found in 50% and 36% of participants, respectively. Increased central fat distribution, as defined by WheiR, WC and WHR, was found in 89.6%, 91.7% and 89.4% individuals, respectively. Univariate linear regression analysis showed positive correlations between CKD and age (p<0.001), BMI (p<0.001), WC (p<0.001), WHR (p=0.007), WheiR (p<0.001), diabetes (p=0.002), as well as triglicerydes (p=0.031), and negative correlation between CKD and HDL level (p=0.017). Multivariable analysis demonstrated that hypertension, diabetes, WC and WheiR were independent predictors of CKD. The area under the receiver operating characteristics curve was best for WheiR (0.647), followed by WC (0.620), BMI (0.616), and WHR (0.532). CONCLUSIONS: Abdominal obesity is an important predictor of CKD. Of commonly used anthropometric parameters of obesity WheiR ≥ 0.6 is particularly associated with CKD in elderly females.

Outpatient oral anticoagulation in Poland in 2012: a single centre experience.

BACKGROUND: Oral anticoagulants reduce embolic complications in patients with atrial fibrillation (AF) and are used in the treatment and prevention of venous thromboembolism. In Poland, chronic oral anticoagulation is usually managed by primary care physicians, and the most commonly used drugs are vitamin K antagonists (VKA). AIM: To evaluate effectiveness of oral anticoagulation in 104 patients receiving chronic VKA treatment in primary care from Jan 01, 2011 to Dec 31, 2011. METHODS: We performed a retrospective analysis of data of 104 patients receiving chronic VKA treatment in a primary care practice (Niepubliczny Zaklad Opieki Zdowotnej ESCULAP Gniewkowo) from Jan 01, 2011 to Dec 31, 2011. These patients comprised 1.1% of the population remaining under care of this primary care practice. We determined minimum, maximum and mean values of the international normalised ratio (INR), the proportion of results within the therapeutic range, the number of INR measurements, and indications for anticoagulant treatment. In patients with AF, we determined the risks of bleeding complications and thrombotic events. RESULTS: Among patients receiving chronic VKA treatment, 56.84% of INR measurements were within the therapeutic range. Only 29.8% of patients had more than 70% of INR measurements within the therapeutic range. We found no association between the number of INR measurements and treatment effectiveness. CONCLUSIONS: The effectiveness of anticoagulation in primary care is unsatisfactory. In our study population, an acceptable time in the therapeutic range was achieved in only just below 30% of patients.